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
9494
Axillary Artery and Vein Cannulation
07-30-2015
11185
Blunt Cardiac Trauma
09-29-2016
5032
Free Flap Management
02-21-2020
6085
Hypertension Management
11-26-2015
10597
Noninvasive Hemodynamic Monitoring
09-29-2016
4799
Resuscitative Balloon Occlusion of the Aorta (REBOA)
08-12-2018
3384
Vasopressors and Inotropes in Shock
09-12-2019
35338


Endocrine

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Critical Illness-Related Corticosteroid Insufficiency
03-03-2015
4564
Hyperglycemia Control in the Critically Ill
12-07-2011
7007
Thyroid Management in the ICU
06-18-2019
3070


Fluids/Electrolytes/Nutrition

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Electrolyte Replacement
08-12-2018
18912
Fluid Resuscitation
11-03-2017
11184
Nasogastric/Nasoenteric Tube Placement in Traumatic Craniofacial Fractures
01-26-2017
6597
Rhabdomyolysis: Prevention and Treatment
08-12-2018
10214


Gastrointestinal

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Cholecystitis
01-08-2015
5820
Acute Gastrointestinal Hemorrhage: Pharmacologic Management
12-13-2017
8466
Blunt Splenic Injury
09-30-2015
5063
Cirrhotic Management
02-25-2016
3779
Clostridium difficile Infection
06-29-2015
4540
Diverticulitis
09-30-2015
3845
Enteral Feeding Guidelines
04-10-2017
11847
Intra-abdominal Pressure Monitoring
03-23-2015
3898
Octreotide in the Prevention and Treatment of Gastrointestinal and Pancreatic Fistulas
11-03-2017
19409
Percutaneous Endoscopic Gastrostomy
06-11-2020
3614
Post-Splenectomy Vaccine Prophylaxis
01-27-2019
8490
Premature Gastrostomy / Jejunostomy Removal
10-21-2009
6330
Small Bowel Obstruction
06-04-2014
3513
Stress Ulcer Prophylaxis
11-03-2017
6205


Hematologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Blood Conservation and Transfusion Avoidance Strategies in the Surgical Patient
06-27-2019
4202
Deep Venous Thrombosis Prophylaxis in the Critically Ill
01-30-2014
7737
Disseminated Intravascular Coagulation
04-10-2017
2971
DVT Prophylaxis in Solid Organ Injury
12-05-2013
3380
Erythropoietin Use in the Critically Ill
02-06-2008
5246
Heparin Induced Thrombocytopenia
09-14-2019
4625
Inferior Vena Caval Filter Use in Patients at High Risk for Pulmonary Embolism
10-28-2009
3391
Massive Transfusion Protocol for Hemorrhagic Shock
05-27-2020
33500
Non-Vitamin K Anticoagulation Reversal
08-12-2018
4601
Thromboelastography (TEG) in Trauma
12-04-2014
6006
Ultrasound Guided Peripheral IV Insertion
05-27-2020
1220
Venous Thromboprophylaxis in Obesity
02-25-2016
14108
Warfarin Dosing
09-01-2009
3902
Warfarin Reversal
11-30-2017
5225


Infectious Disease

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Aerosolized Antibiotic Therapy in the ICU
03-30-2016
3169
Antibiotic Prophylaxis in Surgery
11-30-2013
12383
Candida Infections in Surgical Patients
04-10-2017
5061
Continuous Antibiotic Infusions
05-16-2007
2905
Empiric Antibiotic Use in Critically Ill Patients
05-09-2007
5980
Facial Fracture Antibiotics
04-29-2020
4375
Presumptive Chest Tube Antibiotics
03-07-2013
3307


Neurologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Spinal Cord Injury Guideline
09-11-2018
8820
Antiplatelet Agent Reversal in Adults With Traumatic Intracranial Hemorrhage
04-10-2017
24868
Blunt Cerebrovascular Injury
09-30-2015
4353
Brain Death Determination / Apnea Test Procedure
09-10-2019
7354
Cervical Spine Clearance
12-13-2017
4078
Delirium Management in the ICU
08-12-2018
7574
Hypertonic Saline Bolus & Infusion Instructions
05-27-2020
5514
Methylprednisolone (Solumedrol) in Acute Spinal Cord Injury
08-02-2014
7091
Pain Management in Surgery
09-30-2015
3827
Sedation and Agitation Management in the ICU
10-25-2009
4027
Seizure Prophylaxis in Traumatic Brain Injury
08-01-2017
33450
Severe Traumatic Brain Injury Management
09-11-2019
10955
Syncope Evaluation in the Trauma Patient
09-29-2016
3097
Therapeutic Hypothermia
09-01-2020
3782


Respiratory

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Air Travel Following Traumatic Pneumothorax
03-20-2015
3495
Chest Tube Management
09-29-2016
5017
Diaphragm Pacing
07-18-2019
2066
Extubating the Trauma Patient with an Open Abdomen
06-24-2018
2780
High frequency oscillatory ventilation in the surgical patient
03-04-2009
2972
Independent Lung Ventilation
12-04-2014
2794
Multi-modality Rib Fracture Management
03-05-2020
6580
Peri-Procedural Tracheostomy Complications
01-04-2013
2694
Post-Extubation Stridor
08-01-2017
6005
Post-Tracheostomy Hemorrhage
07-30-2015
4312
Rescue Ventilation
08-22-2018
3523
Retained Hemothorax
04-28-2016
8848
Surgical Fixation of Rib Fractures
09-04-2020
10183
Timing of Tracheostomy
04-29-2020
6222
Tissue Plasminogen Activator in Traumatic Hemothorax
04-01-2018
4494
Ventilator-Associated Pneumonia
02-25-2016
3592


Skin

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Burn Inhalation injury
06-18-2019
3174
Burn Resuscitation
11-26-2019
7800
Ketamine for Analgesia
12-27-2019
5630
Perioperative Hypothermia Prevention in Burn Patients
04-01-2018
7731
Remifentanil Infusion for Adult Burn Dressing Changes
10-29-2009
3376
Snakebite/crotalid Antivenoms
09-28-2018
4227


Miscellaneous

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Alcohol Withdrawal
07-30-2015
4043
Central Venous Catheterization
12-04-2009
6942
Fever Assessment
06-27-2019
7868
Gabapentin in Post-operative Pain Management
09-29-2016
5624
Ketamine for Analgesia
12-13-2017
7658
Laparoscopy in Trauma
02-25-2016
3186
Mangled Extremity
04-28-2016
5065
Muscle Relaxants in Multimodal Pain Management
01-26-2017
5862
Necrotizing Soft Tissues Infections
09-28-2018
5241
Negative Pressure Wound Therapy
02-06-2014
2740
Neuromuscular Blocking Agents in the Adult ICU
08-02-2018
8283



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