Evidence Based-Medicine Guidelines

The following is a collection of best practice guidelines currently in use by the Surgical Critical Care and Acute Care Surgery teams at Orlando Regional Medical Center (ORMC). They are based upon the most recent medical literature and are reviewed and updated on a regular basis. Guidelines that are either or have been within the past 180 days are marked accordingly. Please note that certain aspects of these guidelines, such as antibiotic sensitivities and recommendations, are specific to the adult ICU's at ORMC and may not be applicable to other patient populations. These guidelines may be downloaded and adapted for use in your own intensive care unit. Please contact the Webmaster if you have questions or suggestions regarding these guidelines.

Are you rotating on the ORMC Surgical Critical Care team? If so, watch this brief video describing your involvement with the Evidence-Based Medicine Guideline Committee


The Evidence-Based Medicine Guidelines Committee is pleased to share these guidelines for clinical use in your intensive care unit. If you choose to do so, the Committee requests that the time and effort involved in developing these guidelines be appropriately recognized. All guidelines contained on this site are copyrighted by SurgicalCriticalCare.net unless otherwise indicated.

Guidelines should be referenced in the following manner: Rojas K, Birrer K, Cheatham M, Smith C. Seizure Prophylaxis following Traumatic Brain Injury. http://www.surgicalcriticalcare.net/Guidelines/Seizure prophylaxis in TBI 2017.pdf. Updated July 26, 2017. Accessed November 13, 2017.



Cardiovascular

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Atrial Fibrillation in the Surgical Patient
12-13-2017
7677
Axillary Artery and Vein Cannulation
07-30-2015
9056
Blunt Cardiac Trauma
09-29-2016
3998
Free Flap Management
03-05-2018
3231
Hypertension Management
11-26-2015
8665
Noninvasive Hemodynamic Monitoring
09-29-2016
3949
Resuscitative Balloon Occlusion of the Aorta (REBOA)
08-12-2018
2577
Vasopressors and Inotropes in Shock
09-12-2019
29341


Endocrine

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Critical Illness-Related Corticosteroid Insufficiency
03-03-2015
3593
Hyperglycemia Control in the Critically Ill
12-07-2011
5562
Thyroid Management in the ICU
06-18-2019
1918


Fluids/Electrolytes/Nutrition

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Electrolyte Replacement
08-12-2018
15087
Fluid Resuscitation
11-03-2017
8796
Nasogastric/Nasoenteric Tube Placement in Traumatic Craniofacial Fractures
01-26-2017
4769
Rhabdomyolysis: Prevention and Treatment
08-12-2018
7789


Gastrointestinal

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Cholecystitis
01-08-2015
4715
Acute Gastrointestinal Hemorrhage: Pharmacologic Management
12-13-2017
5898
Blunt Splenic Injury
09-30-2015
4303
Cirrhotic Management
02-25-2016
2935
Clostridium difficile Infection
06-29-2015
3767
Diverticulitis
09-30-2015
2954
Enteral Feeding Guidelines
04-10-2017
8322
Intra-abdominal Pressure Monitoring
03-23-2015
3022
Octreotide in the Prevention and Treatment of Gastrointestinal and Pancreatic Fistulas
11-03-2017
10637
Percutaneous Endoscopic Gastrostomy
06-04-2014
2280
Post-Splenectomy Vaccine Prophylaxis
01-27-2019
7093
Premature Gastrostomy / Jejunostomy Removal
10-21-2009
5051
Small Bowel Obstruction
06-04-2014
2794
Stress Ulcer Prophylaxis
11-03-2017
4871


Hematologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Blood Conservation and Transfusion Avoidance Strategies in the Surgical Patient
06-27-2019
3429
Deep Venous Thrombosis Prophylaxis in the Critically Ill
01-30-2014
6548
Disseminated Intravascular Coagulation
04-10-2017
2294
DVT Prophylaxis in Solid Organ Injury
12-05-2013
2679
Erythropoietin Use in the Critically Ill
02-06-2008
4422
Factor VIIa (Recombinant) (Novoseven®) in Trauma
09-03-2008
2829
Heparin Induced Thrombocytopenia
09-14-2019
3305
Inferior Vena Caval Filter Use in Patients at High Risk for Pulmonary Embolism
10-28-2009
2698
Massive Transfusion Protocol for Hemorrhagic Shock
11-03-2017
26498
Non-Vitamin K Anticoagulation Reversal
08-12-2018
3813
Thromboelastography (TEG) in Trauma
12-04-2014
4748
Venous Thromboprophylaxis in Obesity
02-25-2016
12133
Warfarin Dosing
09-01-2009
3288
Warfarin Reversal
11-30-2017
4333


Infectious Disease

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Aerosolized Antibiotic Therapy in the ICU
03-30-2016
2574
Antibiotic Prophylaxis in Surgery
11-30-2013
11096
Candida Infections in Surgical Patients
04-10-2017
4383
Continuous Antibiotic Infusions
05-16-2007
2301
Empiric Antibiotic Use in Critically Ill Patients
05-09-2007
5122
Facial Fracture Antibiotics
06-27-2019
1582
Presumptive Chest Tube Antibiotics
03-07-2013
2700


Neurologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Spinal Cord Injury Guideline
09-11-2018
7715
Antiplatelet Agent Reversal in Adults With Traumatic Intracranial Hemorrhage
04-10-2017
23318
Blunt Cerebrovascular Injury
09-30-2015
3679
Brain Death Determination / Apnea Test Procedure
09-10-2019
5941
Cervical Spine Clearance
12-13-2017
3351
Delirium Management in the ICU
08-12-2018
5383
Hypertonic Saline Solution Instructions
05-07-2008
3182
Methylprednisolone (Solumedrol) in Acute Spinal Cord Injury
08-02-2014
6473
Pain Management in Surgery
09-30-2015
3157
Sedation and Agitation Management in the ICU
10-25-2009
3213
Seizure Prophylaxis in Traumatic Brain Injury
08-01-2017
27999
Severe Traumatic Brain Injury Management
09-11-2019
8670
Syncope Evaluation in the Trauma Patient
09-29-2016
2445
Therapeutic Hypothermia
02-25-2016
2790


Respiratory

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Air Travel Following Traumatic Pneumothorax
03-20-2015
2793
Chest Tube Management
09-29-2016
3898
Diaphragm Pacing
07-18-2019
1416
Extubating the Trauma Patient with an Open Abdomen
06-24-2018
1965
High frequency oscillatory ventilation in the surgical patient
03-04-2009
2424
Independent Lung Ventilation
12-04-2014
2200
Multi-modality Rib Fracture Management
12-01-2010
4137
Paracostal Infusion of Bupivacaine for Management of Rib Fracture Pain
04-21-2010
4282
Peri-Procedural Tracheostomy Complications
01-04-2013
2132
Post-Extubation Stridor
08-01-2017
5370
Post-Tracheostomy Hemorrhage
07-30-2015
3347
Rescue Ventilation
08-22-2018
2525
Retained Hemothorax
04-28-2016
7129
Surgical Fixation of Rib Fractures
02-07-2013
9285
Timing of Tracheostomy
09-30-2015
4248
Tissue Plasminogen Activator in Traumatic Hemothorax
04-01-2018
3425
Ventilator-Associated Pneumonia
02-25-2016
2831


Skin

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Burn Inhalation injury
06-18-2019
1702
Burn Resuscitation
11-26-2019
4732
Ketamine for Analgesia
12-27-2019
3922
Perioperative Hypothermia Prevention in Burn Patients
04-01-2018
4854
Remifentanil Infusion for Adult Burn Dressing Changes
10-29-2009
2720
Snakebite/crotalid Antivenoms
09-28-2018
3347


Miscellaneous

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Alcohol Withdrawal
07-30-2015
3216
Central Venous Catheterization
12-04-2009
6067
Fever Assessment
06-27-2019
6086
Gabapentin in Post-operative Pain Management
09-29-2016
4953
Ketamine for Analgesia
12-13-2017
5060
Laparoscopy in Trauma
02-25-2016
2527
Mangled Extremity
04-28-2016
4025
Muscle Relaxants in Multimodal Pain Management
01-26-2017
4603
Necrotizing Soft Tissues Infections
09-28-2018
3837
Negative Pressure Wound Therapy
02-06-2014
2195
Neuromuscular Blocking Agents in the Adult ICU
08-02-2018
6545



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