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
7371
Axillary Artery and Vein Cannulation
07-30-2015
8748
Blunt Cardiac Trauma
09-29-2016
3818
Free Flap Management
03-05-2018
2995
Hypertension Management
11-26-2015
8309
Noninvasive Hemodynamic Monitoring
09-29-2016
3784
Resuscitative Balloon Occlusion of the Aorta (REBOA)
08-12-2018
2372
Vasopressors and Inotropes in Shock
09-12-2019
28007


Endocrine

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Critical Illness-Related Corticosteroid Insufficiency
03-03-2015
3418
Hyperglycemia Control in the Critically Ill
12-07-2011
5311
Thyroid Management in the ICU
06-18-2019
1611


Fluids/Electrolytes/Nutrition

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Electrolyte Replacement
08-12-2018
14183
Fluid Resuscitation
11-03-2017
8531
Nasogastric/Nasoenteric Tube Placement in Traumatic Craniofacial Fractures
01-26-2017
4463
Rhabdomyolysis: Prevention and Treatment
08-12-2018
7341


Gastrointestinal

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Cholecystitis
01-08-2015
4500
Acute Gastrointestinal Hemorrhage: Pharmacologic Management
12-13-2017
5522
Blunt Splenic Injury
09-30-2015
4134
Cirrhotic Management
02-25-2016
2764
Clostridium difficile Infection
06-29-2015
3585
Diverticulitis
09-30-2015
2811
Enteral Feeding Guidelines
04-10-2017
7785
Intra-abdominal Pressure Monitoring
03-23-2015
2853
Octreotide in the Prevention and Treatment of Gastrointestinal and Pancreatic Fistulas
11-03-2017
10025
Percutaneous Endoscopic Gastrostomy
06-04-2014
2130
Post-Splenectomy Vaccine Prophylaxis
01-27-2019
6895
Premature Gastrostomy / Jejunostomy Removal
10-21-2009
4812
Small Bowel Obstruction
06-04-2014
2634
Stress Ulcer Prophylaxis
11-03-2017
4622


Hematologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Blood Conservation and Transfusion Avoidance Strategies in the Surgical Patient
06-27-2019
3164
Deep Venous Thrombosis Prophylaxis in the Critically Ill
01-30-2014
6266
Disseminated Intravascular Coagulation
04-10-2017
2150
DVT Prophylaxis in Solid Organ Injury
12-05-2013
2553
Erythropoietin Use in the Critically Ill
02-06-2008
4275
Factor VIIa (Recombinant) (Novoseven®) in Trauma
09-03-2008
2705
Heparin Induced Thrombocytopenia
09-14-2019
2911
Inferior Vena Caval Filter Use in Patients at High Risk for Pulmonary Embolism
10-28-2009
2589
Massive Transfusion Protocol for Hemorrhagic Shock
11-03-2017
25457
Non-Vitamin K Anticoagulation Reversal
08-12-2018
3670
Thromboelastography (TEG) in Trauma
12-04-2014
4508
Venous Thromboprophylaxis in Obesity
02-25-2016
11582
Warfarin Dosing
09-01-2009
3179
Warfarin Reversal
11-30-2017
4168


Infectious Disease

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Aerosolized Antibiotic Therapy in the ICU
03-30-2016
2484
Antibiotic Prophylaxis in Surgery
11-30-2013
10854
Candida Infections in Surgical Patients
04-10-2017
4283
Continuous Antibiotic Infusions
05-16-2007
2204
Empiric Antibiotic Use in Critically Ill Patients
05-09-2007
4977
Facial Fracture Antibiotics
06-27-2019
1329
Presumptive Chest Tube Antibiotics
03-07-2013
2601


Neurologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Spinal Cord Injury Guideline
09-11-2018
7480
Antiplatelet Agent Reversal in Adults With Traumatic Intracranial Hemorrhage
04-10-2017
23145
Blunt Cerebrovascular Injury
09-30-2015
3552
Brain Death Determination / Apnea Test Procedure
09-10-2019
5481
Cervical Spine Clearance
12-13-2017
3217
Delirium Management in the ICU
08-12-2018
5088
Hypertonic Saline Solution Instructions
05-07-2008
3049
Methylprednisolone (Solumedrol) in Acute Spinal Cord Injury
08-02-2014
6352
Pain Management in Surgery
09-30-2015
3029
Sedation and Agitation Management in the ICU
10-25-2009
3076
Seizure Prophylaxis in Traumatic Brain Injury
08-01-2017
27199
Severe Traumatic Brain Injury Management
09-11-2019
7989
Syncope Evaluation in the Trauma Patient
09-29-2016
2319
Therapeutic Hypothermia
02-25-2016
2659


Respiratory

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Air Travel Following Traumatic Pneumothorax
03-20-2015
2686
Chest Tube Management
09-29-2016
3704
Diaphragm Pacing
07-18-2019
1044
Extubating the Trauma Patient with an Open Abdomen
06-24-2018
1824
High frequency oscillatory ventilation in the surgical patient
03-04-2009
2320
Independent Lung Ventilation
12-04-2014
2117
Multi-modality Rib Fracture Management
12-01-2010
3996
Paracostal Infusion of Bupivacaine for Management of Rib Fracture Pain
04-21-2010
4131
Peri-Procedural Tracheostomy Complications
01-04-2013
2050
Post-Extubation Stridor
08-01-2017
5245
Post-Tracheostomy Hemorrhage
07-30-2015
3198
Rescue Ventilation
08-22-2018
2362
Retained Hemothorax
04-28-2016
6857
Surgical Fixation of Rib Fractures
02-07-2013
9148
Timing of Tracheostomy
09-30-2015
4129
Tissue Plasminogen Activator in Traumatic Hemothorax
04-01-2018
3231
Ventilator-Associated Pneumonia
02-25-2016
2698


Skin

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Burn Inhalation injury
06-18-2019
1484
Burn Resuscitation
11-26-2019
4190
Ketamine Sedation for Adult Burn Dressing Changes
12-07-2013
3685
Perioperative Hypothermia Prevention in Burn Patients
04-01-2018
4396
Remifentanil Infusion for Adult Burn Dressing Changes
10-29-2009
2628
Snakebite/crotalid Antivenoms
09-28-2018
3245


Miscellaneous

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Alcohol Withdrawal
07-30-2015
3046
Central Venous Catheterization
12-04-2009
5909
Fever Assessment
06-27-2019
5708
Gabapentin in Post-operative Pain Management
09-29-2016
4841
Ketamine for Analgesia
12-13-2017
4671
Laparoscopy in Trauma
02-25-2016
2385
Mangled Extremity
04-28-2016
3836
Muscle Relaxants in Multimodal Pain Management
01-26-2017
4387
Necrotizing Soft Tissues Infections
09-28-2018
3550
Negative Pressure Wound Therapy
02-06-2014
2101
Neuromuscular Blocking Agents in the Adult ICU
08-02-2018
6218



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