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
8232
Axillary Artery and Vein Cannulation
07-30-2015
9463
Blunt Cardiac Trauma
09-29-2016
4254
Free Flap Management
02-21-2020
3727
Hypertension Management
11-26-2015
9120
Noninvasive Hemodynamic Monitoring
09-29-2016
4166
Resuscitative Balloon Occlusion of the Aorta (REBOA)
08-12-2018
2832
Vasopressors and Inotropes in Shock
09-12-2019
30854


Endocrine

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Critical Illness-Related Corticosteroid Insufficiency
03-03-2015
3873
Hyperglycemia Control in the Critically Ill
12-07-2011
5997
Thyroid Management in the ICU
06-18-2019
2260


Fluids/Electrolytes/Nutrition

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Electrolyte Replacement
08-12-2018
16016
Fluid Resuscitation
11-03-2017
9287
Nasogastric/Nasoenteric Tube Placement in Traumatic Craniofacial Fractures
01-26-2017
5211
Rhabdomyolysis: Prevention and Treatment
08-12-2018
8467


Gastrointestinal

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Cholecystitis
01-08-2015
4985
Acute Gastrointestinal Hemorrhage: Pharmacologic Management
12-13-2017
6390
Blunt Splenic Injury
09-30-2015
4515
Cirrhotic Management
02-25-2016
3173
Clostridium difficile Infection
06-29-2015
3982
Diverticulitis
09-30-2015
3296
Enteral Feeding Guidelines
04-10-2017
9259
Intra-abdominal Pressure Monitoring
03-23-2015
3225
Octreotide in the Prevention and Treatment of Gastrointestinal and Pancreatic Fistulas
11-03-2017
11519
Percutaneous Endoscopic Gastrostomy
06-04-2014
2456
Post-Splenectomy Vaccine Prophylaxis
01-27-2019
7436
Premature Gastrostomy / Jejunostomy Removal
10-21-2009
5356
Small Bowel Obstruction
06-04-2014
2987
Stress Ulcer Prophylaxis
11-03-2017
5200


Hematologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Blood Conservation and Transfusion Avoidance Strategies in the Surgical Patient
06-27-2019
3666
Deep Venous Thrombosis Prophylaxis in the Critically Ill
01-30-2014
6877
Disseminated Intravascular Coagulation
04-10-2017
2485
DVT Prophylaxis in Solid Organ Injury
12-05-2013
2863
Erythropoietin Use in the Critically Ill
02-06-2008
4624
Factor VIIa (Recombinant) (Novoseven®) in Trauma
09-03-2008
2998
Heparin Induced Thrombocytopenia
09-14-2019
3758
Inferior Vena Caval Filter Use in Patients at High Risk for Pulmonary Embolism
10-28-2009
2874
Massive Transfusion Protocol for Hemorrhagic Shock
11-03-2017
27876
Non-Vitamin K Anticoagulation Reversal
08-12-2018
4003
Thromboelastography (TEG) in Trauma
12-04-2014
5070
Venous Thromboprophylaxis in Obesity
02-25-2016
12752
Warfarin Dosing
09-01-2009
3445
Warfarin Reversal
11-30-2017
4569


Infectious Disease

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Aerosolized Antibiotic Therapy in the ICU
03-30-2016
2753
Antibiotic Prophylaxis in Surgery
11-30-2013
11518
Candida Infections in Surgical Patients
04-10-2017
4575
Continuous Antibiotic Infusions
05-16-2007
2472
Empiric Antibiotic Use in Critically Ill Patients
05-09-2007
5335
Facial Fracture Antibiotics
06-27-2019
1821
Presumptive Chest Tube Antibiotics
03-07-2013
2891


Neurologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Spinal Cord Injury Guideline
09-11-2018
8011
Antiplatelet Agent Reversal in Adults With Traumatic Intracranial Hemorrhage
04-10-2017
23589
Blunt Cerebrovascular Injury
09-30-2015
3857
Brain Death Determination / Apnea Test Procedure
09-10-2019
6364
Cervical Spine Clearance
12-13-2017
3561
Delirium Management in the ICU
08-12-2018
5840
Hypertonic Saline Solution Instructions
05-07-2008
3366
Methylprednisolone (Solumedrol) in Acute Spinal Cord Injury
08-02-2014
6651
Pain Management in Surgery
09-30-2015
3357
Sedation and Agitation Management in the ICU
10-25-2009
3419
Seizure Prophylaxis in Traumatic Brain Injury
08-01-2017
29247
Severe Traumatic Brain Injury Management
09-11-2019
9378
Syncope Evaluation in the Trauma Patient
09-29-2016
2639
Therapeutic Hypothermia
02-25-2016
2989


Respiratory

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Air Travel Following Traumatic Pneumothorax
03-20-2015
3007
Chest Tube Management
09-29-2016
4161
Diaphragm Pacing
07-18-2019
1612
Extubating the Trauma Patient with an Open Abdomen
06-24-2018
2198
High frequency oscillatory ventilation in the surgical patient
03-04-2009
2597
Independent Lung Ventilation
12-04-2014
2358
Multi-modality Rib Fracture Management
03-05-2020
4536
Peri-Procedural Tracheostomy Complications
01-04-2013
2299
Post-Extubation Stridor
08-01-2017
5543
Post-Tracheostomy Hemorrhage
07-30-2015
3570
Rescue Ventilation
08-22-2018
2864
Retained Hemothorax
04-28-2016
7527
Surgical Fixation of Rib Fractures
02-07-2013
9508
Timing of Tracheostomy
09-30-2015
4472
Tissue Plasminogen Activator in Traumatic Hemothorax
04-01-2018
3710
Ventilator-Associated Pneumonia
02-25-2016
3058


Skin

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Burn Inhalation injury
06-18-2019
1971
Burn Resuscitation
11-26-2019
5498
Ketamine for Analgesia
12-27-2019
4466
Perioperative Hypothermia Prevention in Burn Patients
04-01-2018
5737
Remifentanil Infusion for Adult Burn Dressing Changes
10-29-2009
2890
Snakebite/crotalid Antivenoms
09-28-2018
3550


Miscellaneous

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Alcohol Withdrawal
07-30-2015
3449
Central Venous Catheterization
12-04-2009
6302
Fever Assessment
06-27-2019
6600
Gabapentin in Post-operative Pain Management
09-29-2016
5142
Ketamine for Analgesia
12-13-2017
5618
Laparoscopy in Trauma
02-25-2016
2719
Mangled Extremity
04-28-2016
4316
Muscle Relaxants in Multimodal Pain Management
01-26-2017
4934
Necrotizing Soft Tissues Infections
09-28-2018
4190
Negative Pressure Wound Therapy
02-06-2014
2352
Neuromuscular Blocking Agents in the Adult ICU
08-02-2018
7049



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