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
6847
Axillary Artery and Vein Cannulation
07-30-2015
8199
Blunt Cardiac Trauma
09-29-2016
3506
Free Flap Management
03-05-2018
2489
Hypertension Management
11-26-2015
7676
Noninvasive Hemodynamic Monitoring
09-29-2016
3463
Resuscitative Balloon Occlusion of the Aorta (REBOA)
08-12-2018
2020
Vasopressors and Inotropes in Shock
09-12-2019
26282


Endocrine

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Critical Illness-Related Corticosteroid Insufficiency
03-03-2015
3070
Hyperglycemia Control in the Critically Ill
12-07-2011
4887
Thyroid Management in the ICU
06-18-2019
825


Fluids/Electrolytes/Nutrition

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Electrolyte Replacement
08-12-2018
12930
Fluid Resuscitation
11-03-2017
6079
Nasogastric/Nasoenteric Tube Placement in Traumatic Craniofacial Fractures
01-26-2017
3863
Rhabdomyolysis: Prevention and Treatment
08-12-2018
5884


Gastrointestinal

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Cholecystitis
01-08-2015
4098
Acute Gastrointestinal Hemorrhage: Pharmacologic Management
12-13-2017
5010
Blunt Splenic Injury
09-30-2015
3848
Cirrhotic Management
02-25-2016
2500
Clostridium difficile Infection
06-29-2015
3298
Diverticulitis
09-30-2015
2534
Enteral Feeding Guidelines
04-10-2017
6982
Intra-abdominal Pressure Monitoring
03-23-2015
2585
Octreotide in the Prevention and Treatment of Gastrointestinal and Pancreatic Fistulas
11-03-2017
8728
Percutaneous Endoscopic Gastrostomy
06-04-2014
1914
Post-Splenectomy Vaccine Prophylaxis
01-27-2019
3556
Premature Gastrostomy / Jejunostomy Removal
10-21-2009
4421
Small Bowel Obstruction
06-04-2014
2362
Stress Ulcer Prophylaxis
11-03-2017
4258


Hematologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Blood Conservation and Transfusion Avoidance Strategies in the Surgical Patient
06-27-2019
2490
Deep Venous Thrombosis Prophylaxis in the Critically Ill
01-30-2014
5829
Disseminated Intravascular Coagulation
04-10-2017
1928
DVT Prophylaxis in Solid Organ Injury
12-05-2013
2298
Erythropoietin Use in the Critically Ill
02-06-2008
3980
Factor VIIa (Recombinant) (Novoseven®) in Trauma
09-03-2008
2483
Heparin Induced Thrombocytopenia
09-14-2019
2277
Inferior Vena Caval Filter Use in Patients at High Risk for Pulmonary Embolism
10-28-2009
2347
Massive Transfusion Protocol for Hemorrhagic Shock
11-03-2017
23500
Non-Vitamin K Anticoagulation Reversal
08-12-2018
3420
Thromboelastography (TEG) in Trauma
12-04-2014
4069
Venous Thromboprophylaxis in Obesity
02-25-2016
10692
Warfarin Dosing
09-01-2009
2955
Warfarin Reversal
11-30-2017
3875


Infectious Disease

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Aerosolized Antibiotic Therapy in the ICU
03-30-2016
2305
Antibiotic Prophylaxis in Surgery
11-30-2013
9781
Candida Infections in Surgical Patients
04-10-2017
4069
Continuous Antibiotic Infusions
05-16-2007
1990
Empiric Antibiotic Use in Critically Ill Patients
05-09-2007
4680
Facial Fracture Antibiotics
06-27-2019
614
Presumptive Chest Tube Antibiotics
03-07-2013
2416


Neurologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Spinal Cord Injury Guideline
09-11-2018
7008
Antiplatelet Agent Reversal in Adults With Traumatic Intracranial Hemorrhage
04-10-2017
22795
Blunt Cerebrovascular Injury
09-30-2015
3335
Brain Death Determination / Apnea Test Procedure
09-10-2019
4619
Cervical Spine Clearance
12-13-2017
2978
Delirium Management in the ICU
08-12-2018
4517
Hypertonic Saline Solution Instructions
05-07-2008
2800
Methylprednisolone (Solumedrol) in Acute Spinal Cord Injury
08-02-2014
6108
Pain Management in Surgery
09-30-2015
2817
Sedation and Agitation Management in the ICU
10-25-2009
2827
Seizure Prophylaxis in Traumatic Brain Injury
08-01-2017
26035
Severe Traumatic Brain Injury Management
09-11-2019
6914
Syncope Evaluation in the Trauma Patient
09-29-2016
2102
Therapeutic Hypothermia
02-25-2016
2422


Respiratory

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Air Travel Following Traumatic Pneumothorax
03-20-2015
2482
Chest Tube Management
09-29-2016
3400
Diaphragm Pacing
07-18-2019
436
Extubating the Trauma Patient with an Open Abdomen
06-24-2018
1551
High frequency oscillatory ventilation in the surgical patient
03-04-2009
2113
Independent Lung Ventilation
12-04-2014
1938
Multi-modality Rib Fracture Management
12-01-2010
3723
Paracostal Infusion of Bupivacaine for Management of Rib Fracture Pain
04-21-2010
3857
Peri-Procedural Tracheostomy Complications
01-04-2013
1879
Post-Extubation Stridor
08-01-2017
5012
Post-Tracheostomy Hemorrhage
07-30-2015
2948
Rescue Ventilation
08-22-2018
2065
Retained Hemothorax
04-28-2016
6214
Surgical Fixation of Rib Fractures
02-07-2013
8897
Timing of Tracheostomy
09-30-2015
3856
Tissue Plasminogen Activator in Traumatic Hemothorax
04-01-2018
2911
Ventilator-Associated Pneumonia
02-25-2016
2474


Skin

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Burn Inhalation injury
06-18-2019
760
Burn Resuscitation
06-18-2019
3331
Ketamine Sedation for Adult Burn Dressing Changes
12-07-2013
3482
Perioperative Hypothermia Prevention in Burn Patients
04-01-2018
3409
Remifentanil Infusion for Adult Burn Dressing Changes
10-29-2009
2430
Snakebite/crotalid Antivenoms
09-28-2018
3015


Miscellaneous

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Alcohol Withdrawal
07-30-2015
2763
Central Venous Catheterization
12-04-2009
5596
Fever Assessment
06-27-2019
4791
Gabapentin in Post-operative Pain Management
09-29-2016
4597
Ketamine for Analgesia
12-13-2017
3943
Laparoscopy in Trauma
02-25-2016
2195
Mangled Extremity
04-28-2016
3492
Muscle Relaxants in Multimodal Pain Management
01-26-2017
3995
Necrotizing Soft Tissues Infections
09-28-2018
3081
Negative Pressure Wound Therapy
02-06-2014
1913
Neuromuscular Blocking Agents in the Adult ICU
08-02-2018
5694



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