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
6441
Axillary Artery and Vein Cannulation
07-30-2015
7798
Blunt Cardiac Trauma
09-29-2016
3295
Free Flap Management
03-05-2018
2142
Hypertension Management
11-26-2015
7222
Noninvasive Hemodynamic Monitoring
09-29-2016
3238
Resuscitative Balloon Occlusion of the Aorta (REBOA)
08-12-2018
1778
Vasopressors and Inotropes in Shock
04-20-2011
25880


Endocrine

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Critical Illness-Related Corticosteroid Insufficiency
03-03-2015
2836
Hyperglycemia Control in the Critically Ill
12-07-2011
4595
Thyroid Management in the ICU
06-18-2019
266


Fluids/Electrolytes/Nutrition

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Electrolyte Replacement
08-12-2018
11725
Fluid Resuscitation
11-03-2017
5700
Nasogastric/Nasoenteric Tube Placement in Traumatic Craniofacial Fractures
01-26-2017
3528
Rhabdomyolysis: Prevention and Treatment
08-12-2018
5141


Gastrointestinal

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Cholecystitis
01-08-2015
3821
Acute Gastrointestinal Hemorrhage: Pharmacologic Management
12-13-2017
4681
Blunt Splenic Injury
09-30-2015
3652
Cirrhotic Management
02-25-2016
2311
Clostridium difficile Infection
06-29-2015
3097
Diverticulitis
09-30-2015
2343
Enteral Feeding Guidelines
04-10-2017
6517
Intra-abdominal Pressure Monitoring
03-23-2015
2394
Octreotide in the Prevention and Treatment of Gastrointestinal and Pancreatic Fistulas
11-03-2017
7918
Percutaneous Endoscopic Gastrostomy
06-04-2014
1771
Post-Splenectomy Vaccine Prophylaxis
01-27-2019
3284
Premature Gastrostomy / Jejunostomy Removal
10-21-2009
4159
Small Bowel Obstruction
06-04-2014
2178
Stress Ulcer Prophylaxis
11-03-2017
4010


Hematologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Blood Conservation and Transfusion Avoidance Strategies in the Surgical Patient
06-27-2019
1993
Deep Venous Thrombosis Prophylaxis in the Critically Ill
01-30-2014
5555
Disseminated Intravascular Coagulation
04-10-2017
1774
DVT Prophylaxis in Solid Organ Injury
12-05-2013
2137
Erythropoietin Use in the Critically Ill
02-06-2008
3760
Factor VIIa (Recombinant) (Novoseven®) in Trauma
09-03-2008
2330
Heparin Induced Thrombocytopenia
09-05-2013
2123
Inferior Vena Caval Filter Use in Patients at High Risk for Pulmonary Embolism
10-28-2009
2191
Massive Transfusion Protocol for Hemorrhagic Shock
11-03-2017
22257
Non-Vitamin K Anticoagulation Reversal
08-12-2018
3224
Thromboelastography (TEG) in Trauma
12-04-2014
3780
Venous Thromboprophylaxis in Obesity
02-25-2016
10248
Warfarin Dosing
09-01-2009
2791
Warfarin Reversal
11-30-2017
3645


Infectious Disease

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Aerosolized Antibiotic Therapy in the ICU
03-30-2016
2181
Antibiotic Prophylaxis in Surgery
11-30-2013
9456
Candida Infections in Surgical Patients
04-10-2017
3921
Continuous Antibiotic Infusions
05-16-2007
1849
Empiric Antibiotic Use in Critically Ill Patients
05-09-2007
4485
Presumptive Chest Tube Antibiotics
03-07-2013
2259


Neurologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Spinal Cord Injury Guideline
09-11-2018
6722
Antiplatelet Agent Reversal in Adults With Traumatic Intracranial Hemorrhage
04-10-2017
22534
Blunt Cerebrovascular Injury
09-30-2015
3174
Brain Death Determination / Apnea Test Procedure
09-30-2015
4330
Cervical Spine Clearance
12-13-2017
2812
Delirium Management in the ICU
08-12-2018
4101
Hypertonic Saline Solution Instructions
05-07-2008
2636
Methylprednisolone (Solumedrol) in Acute Spinal Cord Injury
08-02-2014
5936
Pain Management in Surgery
09-30-2015
2677
Sedation and Agitation Management in the ICU
10-25-2009
2653
Seizure Prophylaxis in Traumatic Brain Injury
08-01-2017
25800
Severe Traumatic Brain Injury Management
06-27-2019
6110
Syncope Evaluation in the Trauma Patient
09-29-2016
1970
Therapeutic Hypothermia
02-25-2016
2268


Respiratory

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Air Travel Following Traumatic Pneumothorax
03-20-2015
2305
Chest Tube Management
09-29-2016
3163
Extubating the Trauma Patient with an Open Abdomen
06-24-2018
1366
High frequency oscillatory ventilation in the surgical patient
03-04-2009
1978
Independent Lung Ventilation
12-04-2014
1809
Multi-modality Rib Fracture Management
12-01-2010
3525
Paracostal Infusion of Bupivacaine for Management of Rib Fracture Pain
04-21-2010
3662
Peri-Procedural Tracheostomy Complications
01-04-2013
1739
Post-Extubation Stridor
08-01-2017
4866
Post-Tracheostomy Hemorrhage
07-30-2015
2764
Rescue Ventilation
08-22-2018
1836
Retained Hemothorax
04-28-2016
5838
Surgical Fixation of Rib Fractures
02-07-2013
8713
Timing of Tracheostomy
09-30-2015
3663
Tissue Plasminogen Activator in Traumatic Hemothorax
04-01-2018
2695
Ventilator-Associated Pneumonia
02-25-2016
2329


Skin

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Burn Inhalation injury
06-18-2019
267
Burn Resuscitation
06-18-2019
2772
Ketamine Sedation for Adult Burn Dressing Changes
12-07-2013
3340
Perioperative Hypothermia Prevention in Burn Patients
04-01-2018
2838
Remifentanil Infusion for Adult Burn Dressing Changes
10-29-2009
2291
Snakebite/crotalid Antivenoms
09-28-2018
2821


Miscellaneous

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Alcohol Withdrawal
07-30-2015
2564
Central Venous Catheterization
12-04-2009
5353
Fever Assessment
06-27-2019
4069
Gabapentin in Post-operative Pain Management
09-29-2016
4422
Ketamine for Analgesia
12-13-2017
3473
Laparoscopy in Trauma
02-25-2016
2059
Mangled Extremity
04-28-2016
3263
Muscle Relaxants in Multimodal Pain Management
01-26-2017
3661
Necrotizing Soft Tissues Infections
09-28-2018
2868
Negative Pressure Wound Therapy
02-06-2014
1772
Neuromuscular Blocking Agents in the Adult ICU
08-02-2018
5428



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