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
12-12-2017
4194
Axillary Artery and Vein Cannulation
07-29-2015
4730
Blunt Cardiac Trauma
09-28-2016
2062
Free Flap Management
03-04-2018
601
Hypertension Management
11-25-2015
3898
Noninvasive Hemodynamic Monitoring
09-28-2016
2117
Vasopressors and Inotropes in Shock
04-19-2011
23954


Endocrine

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Critical Illness-Related Corticosteroid Insufficiency
03-02-2015
1837
Hyperglycemia Control in the Critically Ill
12-06-2011
2596


Fluids/Electrolytes/Nutrition

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Electrolyte Replacement
01-14-2008
6516
Fluid Resuscitation
11-02-2017
3474
Nasogastric/Nasoenteric Tube Placement in Traumatic Craniofacial Fractures
01-25-2017
1623
Rhabdomyolysis: Prevention and Treatment
07-29-2015
1965


Gastrointestinal

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Cholecystitis
01-07-2015
2287
Acute Gastrointestinal Hemorrhage: Pharmacologic Management
12-12-2017
2742
Blunt Splenic Injury
09-29-2015
2418
Cirrhotic Management
02-24-2016
1410
Clostridium difficile Infection
06-28-2015
2017
Diverticulitis
09-29-2015
1493
Enteral Feeding Guidelines
04-09-2017
3050
Intra-abdominal Pressure Monitoring
03-22-2015
1531
Octreotide in the Prevention and Treatment of Gastrointestinal and Pancreatic Fistulas
11-02-2017
2778
Percutaneous Endoscopic Gastrostomy
06-03-2014
1112
Post-Splenectomy Vaccine Prophylaxis
07-29-2015
1531
Premature Gastrostomy / Jejunostomy Removal
10-20-2009
2617
Small Bowel Obstruction
06-03-2014
1370
Stress Ulcer Prophylaxis
11-02-2017
2458


Hematologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Blood Conservation and Transfusion Avoidance Strategies in the Surgical Patient
10-24-2009
1218
Deep Venous Thrombosis Prophylaxis in the Critically Ill
01-29-2014
3571
Disseminated Intravascular Coagulation
04-09-2017
1081
DVT Prophylaxis in Solid Organ Injury
12-04-2013
1409
Erythropoietin Use in the Critically Ill
02-05-2008
2506
Factor VIIa (Recombinant) (Novoseven®) in Trauma
09-02-2008
1702
Heparin Induced Thrombocytopenia
09-04-2013
1393
Inferior Vena Caval Filter Use in Patients at High Risk for Pulmonary Embolism
10-27-2009
1404
Massive Transfusion Protocol for Hemorrhagic Shock
11-02-2017
12410
Non-Vitamin K Anticoagulation Reversal
03-29-2016
1758
Thromboelastography (TEG) in Trauma
12-03-2014
2285
Venous Thromboprophylaxis in Obesity
02-24-2016
6984
Warfarin Dosing
08-31-2009
2038
Warfarin Reversal
11-29-2017
2362


Infectious Disease

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Aerosolized Antibiotic Therapy in the ICU
03-29-2016
1373
Antibiotic Prophylaxis in Surgery
11-29-2013
6544
Ascorbic Acid in Sepsis
03-31-2018
194
Candida Infections in Surgical Patients
04-09-2017
3170
Continuous Antibiotic Infusions
05-15-2007
1193
Empiric Antibiotic Use in Critically Ill Patients
05-08-2007
3448
Presumptive Chest Tube Antibiotics
03-06-2013
1575


Neurologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Spinal Cord Injury Guideline
12-10-2015
2469
Antiplatelet Agent Reversal in Adults With Traumatic Intracranial Hemorrhage
04-09-2017
10214
Blunt Cerebrovascular Injury
09-29-2015
2249
Brain Death Determination / Apnea Test Procedure
09-29-2015
2774
Cervical Spine Clearance
12-12-2017
1734
Delirium Management in the ICU
01-04-2011
1599
Hypertonic Saline Solution Instructions
05-06-2008
1756
Methylprednisolone (Solumedrol) in Acute Spinal Cord Injury
08-01-2014
4926
Pain Management in Surgery
09-29-2015
1884
Sedation and Agitation Management in the ICU
10-24-2009
1644
Seizure Prophylaxis in Traumatic Brain Injury
07-31-2017
13894
Severe Traumatic Brain Injury Management
05-04-2017
3983
Syncope Evaluation in the Trauma Patient
09-28-2016
1242
Therapeutic Hypothermia
02-24-2016
1464


Respiratory

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Air Travel Following Traumatic Pneumothorax
03-19-2015
1517
Chest Tube Management
09-28-2016
1865
Extubating the Trauma Patient with an Open Abdomen
06-23-2018
85
Extubation and the Open Abdomen
01-25-2017
1307
High frequency oscillatory ventilation in the surgical patient
03-03-2009
1307
Independent Lung Ventilation
12-03-2014
1126
Multi-modality Rib Fracture Management
11-30-2010
2272
Paracostal Infusion of Bupivacaine for Management of Rib Fracture Pain
04-20-2010
2507
Peri-Procedural Tracheostomy Complications
01-03-2013
1141
Post-Extubation Stridor
07-31-2017
4094
Post-Tracheostomy Hemorrhage
07-29-2015
1722
Retained Hemothorax
04-27-2016
3546
Surgical Fixation of Rib Fractures
02-06-2013
7756
Timing of Tracheostomy
09-29-2015
2407
Tissue Plasminogen Activator in Traumatic Hemothorax
03-31-2018
1355
Ventilator-Associated Pneumonia
02-24-2016
1617


Skin

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Burn Resuscitation
12-04-2013
1552
Ascorbic Acid Infusion (Vitamin C) Infusion in the Resuscitation of Burn Patients
11-29-2013
1349
Ketamine Sedation for Adult Burn Dressing Changes
12-06-2013
2579
Perioperative Hypothermia Prevention in Burn Patients
03-31-2018
112
Remifentanil Infusion for Adult Burn Dressing Changes
10-28-2009
1499
Snakebite/crotalid Antivenoms
11-30-2010
1375


Miscellaneous

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Alcohol Withdrawal
07-29-2015
1618
Central Venous Catheterization
12-03-2009
3763
Fever Assessment
01-30-2013
2237
Gabapentin in Post-operative Pain Management
09-28-2016
3397
Ketamine for Analgesia
12-12-2017
1326
Laparoscopy in Trauma
02-24-2016
1406
Mangled Extremity
04-27-2016
1835
Muscle Relaxants in Multimodal Pain Management
01-25-2017
1606
Necrotizing Soft Tissues Infections
06-03-2014
1254
Negative Pressure Wound Therapy
02-05-2014
1111
Neuromuscular Blocking Agents in the Adult ICU
11-08-2013
2510



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