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
7022
Axillary Artery and Vein Cannulation
07-30-2015
8387
Blunt Cardiac Trauma
09-29-2016
3608
Free Flap Management
03-05-2018
2645
Hypertension Management
11-26-2015
7876
Noninvasive Hemodynamic Monitoring
09-29-2016
3561
Resuscitative Balloon Occlusion of the Aorta (REBOA)
08-12-2018
2135
Vasopressors and Inotropes in Shock
09-12-2019
26873


Endocrine

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Critical Illness-Related Corticosteroid Insufficiency
03-03-2015
3182
Hyperglycemia Control in the Critically Ill
12-07-2011
5016
Thyroid Management in the ICU
06-18-2019
1062


Fluids/Electrolytes/Nutrition

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Electrolyte Replacement
08-12-2018
13413
Fluid Resuscitation
11-03-2017
6249
Nasogastric/Nasoenteric Tube Placement in Traumatic Craniofacial Fractures
01-26-2017
4057
Rhabdomyolysis: Prevention and Treatment
08-12-2018
6603


Gastrointestinal

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Cholecystitis
01-08-2015
4215
Acute Gastrointestinal Hemorrhage: Pharmacologic Management
12-13-2017
5152
Blunt Splenic Injury
09-30-2015
3924
Cirrhotic Management
02-25-2016
2577
Clostridium difficile Infection
06-29-2015
3384
Diverticulitis
09-30-2015
2611
Enteral Feeding Guidelines
04-10-2017
7223
Intra-abdominal Pressure Monitoring
03-23-2015
2659
Octreotide in the Prevention and Treatment of Gastrointestinal and Pancreatic Fistulas
11-03-2017
9156
Percutaneous Endoscopic Gastrostomy
06-04-2014
1979
Post-Splenectomy Vaccine Prophylaxis
01-27-2019
3673
Premature Gastrostomy / Jejunostomy Removal
10-21-2009
4542
Small Bowel Obstruction
06-04-2014
2446
Stress Ulcer Prophylaxis
11-03-2017
4365


Hematologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Blood Conservation and Transfusion Avoidance Strategies in the Surgical Patient
06-27-2019
2685
Deep Venous Thrombosis Prophylaxis in the Critically Ill
01-30-2014
5966
Disseminated Intravascular Coagulation
04-10-2017
1999
DVT Prophylaxis in Solid Organ Injury
12-05-2013
2381
Erythropoietin Use in the Critically Ill
02-06-2008
4076
Factor VIIa (Recombinant) (Novoseven®) in Trauma
09-03-2008
2545
Heparin Induced Thrombocytopenia
09-14-2019
2477
Inferior Vena Caval Filter Use in Patients at High Risk for Pulmonary Embolism
10-28-2009
2426
Massive Transfusion Protocol for Hemorrhagic Shock
11-03-2017
24090
Non-Vitamin K Anticoagulation Reversal
08-12-2018
3500
Thromboelastography (TEG) in Trauma
12-04-2014
4219
Venous Thromboprophylaxis in Obesity
02-25-2016
10990
Warfarin Dosing
09-01-2009
3021
Warfarin Reversal
11-30-2017
3966


Infectious Disease

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Aerosolized Antibiotic Therapy in the ICU
03-30-2016
2365
Antibiotic Prophylaxis in Surgery
11-30-2013
10310
Candida Infections in Surgical Patients
04-10-2017
4137
Continuous Antibiotic Infusions
05-16-2007
2067
Empiric Antibiotic Use in Critically Ill Patients
05-09-2007
4772
Facial Fracture Antibiotics
06-27-2019
842
Presumptive Chest Tube Antibiotics
03-07-2013
2477


Neurologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Spinal Cord Injury Guideline
09-11-2018
7165
Antiplatelet Agent Reversal in Adults With Traumatic Intracranial Hemorrhage
04-10-2017
22918
Blunt Cerebrovascular Injury
09-30-2015
3406
Brain Death Determination / Apnea Test Procedure
09-10-2019
4876
Cervical Spine Clearance
12-13-2017
3074
Delirium Management in the ICU
08-12-2018
4723
Hypertonic Saline Solution Instructions
05-07-2008
2886
Methylprednisolone (Solumedrol) in Acute Spinal Cord Injury
08-02-2014
6183
Pain Management in Surgery
09-30-2015
2886
Sedation and Agitation Management in the ICU
10-25-2009
2906
Seizure Prophylaxis in Traumatic Brain Injury
08-01-2017
26146
Severe Traumatic Brain Injury Management
09-11-2019
7273
Syncope Evaluation in the Trauma Patient
09-29-2016
2173
Therapeutic Hypothermia
02-25-2016
2491


Respiratory

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Air Travel Following Traumatic Pneumothorax
03-20-2015
2550
Chest Tube Management
09-29-2016
3507
Diaphragm Pacing
07-18-2019
620
Extubating the Trauma Patient with an Open Abdomen
06-24-2018
1656
High frequency oscillatory ventilation in the surgical patient
03-04-2009
2184
Independent Lung Ventilation
12-04-2014
1995
Multi-modality Rib Fracture Management
12-01-2010
3802
Paracostal Infusion of Bupivacaine for Management of Rib Fracture Pain
04-21-2010
3947
Peri-Procedural Tracheostomy Complications
01-04-2013
1938
Post-Extubation Stridor
08-01-2017
5088
Post-Tracheostomy Hemorrhage
07-30-2015
3021
Rescue Ventilation
08-22-2018
2170
Retained Hemothorax
04-28-2016
6423
Surgical Fixation of Rib Fractures
02-07-2013
8980
Timing of Tracheostomy
09-30-2015
3946
Tissue Plasminogen Activator in Traumatic Hemothorax
04-01-2018
3034
Ventilator-Associated Pneumonia
02-25-2016
2548


Skin

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Burn Inhalation injury
06-18-2019
987
Burn Resuscitation
06-18-2019
3593
Ketamine Sedation for Adult Burn Dressing Changes
12-07-2013
3548
Perioperative Hypothermia Prevention in Burn Patients
04-01-2018
3689
Remifentanil Infusion for Adult Burn Dressing Changes
10-29-2009
2496
Snakebite/crotalid Antivenoms
09-28-2018
3087


Miscellaneous

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Alcohol Withdrawal
07-30-2015
2847
Central Venous Catheterization
12-04-2009
5678
Fever Assessment
06-27-2019
5077
Gabapentin in Post-operative Pain Management
09-29-2016
4667
Ketamine for Analgesia
12-13-2017
4153
Laparoscopy in Trauma
02-25-2016
2253
Mangled Extremity
04-28-2016
3578
Muscle Relaxants in Multimodal Pain Management
01-26-2017
4115
Necrotizing Soft Tissues Infections
09-28-2018
3223
Negative Pressure Wound Therapy
02-06-2014
1969
Neuromuscular Blocking Agents in the Adult ICU
08-02-2018
5833



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