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
8249
Axillary Artery and Vein Cannulation
07-30-2015
9498
Blunt Cardiac Trauma
09-29-2016
4266
Free Flap Management
02-21-2020
3773
Hypertension Management
11-26-2015
9152
Noninvasive Hemodynamic Monitoring
09-29-2016
4178
Resuscitative Balloon Occlusion of the Aorta (REBOA)
08-12-2018
2844
Vasopressors and Inotropes in Shock
09-12-2019
30925


Endocrine

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Critical Illness-Related Corticosteroid Insufficiency
03-03-2015
3884
Hyperglycemia Control in the Critically Ill
12-07-2011
6025
Thyroid Management in the ICU
06-18-2019
2285


Fluids/Electrolytes/Nutrition

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Electrolyte Replacement
08-12-2018
16063
Fluid Resuscitation
11-03-2017
9309
Nasogastric/Nasoenteric Tube Placement in Traumatic Craniofacial Fractures
01-26-2017
5247
Rhabdomyolysis: Prevention and Treatment
08-12-2018
8515


Gastrointestinal

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Cholecystitis
01-08-2015
4996
Acute Gastrointestinal Hemorrhage: Pharmacologic Management
12-13-2017
6425
Blunt Splenic Injury
09-30-2015
4524
Cirrhotic Management
02-25-2016
3187
Clostridium difficile Infection
06-29-2015
3992
Diverticulitis
09-30-2015
3308
Enteral Feeding Guidelines
04-10-2017
9340
Intra-abdominal Pressure Monitoring
03-23-2015
3237
Octreotide in the Prevention and Treatment of Gastrointestinal and Pancreatic Fistulas
11-03-2017
11565
Percutaneous Endoscopic Gastrostomy
06-04-2014
2469
Post-Splenectomy Vaccine Prophylaxis
01-27-2019
7445
Premature Gastrostomy / Jejunostomy Removal
10-21-2009
5377
Small Bowel Obstruction
06-04-2014
2995
Stress Ulcer Prophylaxis
11-03-2017
5212


Hematologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Blood Conservation and Transfusion Avoidance Strategies in the Surgical Patient
06-27-2019
3678
Deep Venous Thrombosis Prophylaxis in the Critically Ill
01-30-2014
6892
Disseminated Intravascular Coagulation
04-10-2017
2500
DVT Prophylaxis in Solid Organ Injury
12-05-2013
2876
Erythropoietin Use in the Critically Ill
02-06-2008
4645
Factor VIIa (Recombinant) (Novoseven®) in Trauma
09-03-2008
3009
Heparin Induced Thrombocytopenia
09-14-2019
3774
Inferior Vena Caval Filter Use in Patients at High Risk for Pulmonary Embolism
10-28-2009
2880
Massive Transfusion Protocol for Hemorrhagic Shock
11-03-2017
27950
Non-Vitamin K Anticoagulation Reversal
08-12-2018
4014
Thromboelastography (TEG) in Trauma
12-04-2014
5083
Venous Thromboprophylaxis in Obesity
02-25-2016
12794
Warfarin Dosing
09-01-2009
3451
Warfarin Reversal
11-30-2017
4583


Infectious Disease

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Aerosolized Antibiotic Therapy in the ICU
03-30-2016
2759
Antibiotic Prophylaxis in Surgery
11-30-2013
11541
Candida Infections in Surgical Patients
04-10-2017
4582
Continuous Antibiotic Infusions
05-16-2007
2480
Empiric Antibiotic Use in Critically Ill Patients
05-09-2007
5355
Facial Fracture Antibiotics
06-27-2019
1836
Presumptive Chest Tube Antibiotics
03-07-2013
2898


Neurologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Spinal Cord Injury Guideline
09-11-2018
8032
Antiplatelet Agent Reversal in Adults With Traumatic Intracranial Hemorrhage
04-10-2017
23598
Blunt Cerebrovascular Injury
09-30-2015
3866
Brain Death Determination / Apnea Test Procedure
09-10-2019
6382
Cervical Spine Clearance
12-13-2017
3571
Delirium Management in the ICU
08-12-2018
5875
Hypertonic Saline Solution Instructions
05-07-2008
3381
Methylprednisolone (Solumedrol) in Acute Spinal Cord Injury
08-02-2014
6662
Pain Management in Surgery
09-30-2015
3377
Sedation and Agitation Management in the ICU
10-25-2009
3446
Seizure Prophylaxis in Traumatic Brain Injury
08-01-2017
29317
Severe Traumatic Brain Injury Management
09-11-2019
9406
Syncope Evaluation in the Trauma Patient
09-29-2016
2648
Therapeutic Hypothermia
02-25-2016
2997


Respiratory

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Air Travel Following Traumatic Pneumothorax
03-20-2015
3022
Chest Tube Management
09-29-2016
4184
Diaphragm Pacing
07-18-2019
1624
Extubating the Trauma Patient with an Open Abdomen
06-24-2018
2205
High frequency oscillatory ventilation in the surgical patient
03-04-2009
2607
Independent Lung Ventilation
12-04-2014
2371
Multi-modality Rib Fracture Management
03-05-2020
4574
Peri-Procedural Tracheostomy Complications
01-04-2013
2307
Post-Extubation Stridor
08-01-2017
5550
Post-Tracheostomy Hemorrhage
07-30-2015
3590
Rescue Ventilation
08-22-2018
2888
Retained Hemothorax
04-28-2016
7552
Surgical Fixation of Rib Fractures
02-07-2013
9520
Timing of Tracheostomy
09-30-2015
4487
Tissue Plasminogen Activator in Traumatic Hemothorax
04-01-2018
3725
Ventilator-Associated Pneumonia
02-25-2016
3069


Skin

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Burn Inhalation injury
06-18-2019
1983
Burn Resuscitation
11-26-2019
5540
Ketamine for Analgesia
12-27-2019
4503
Perioperative Hypothermia Prevention in Burn Patients
04-01-2018
5838
Remifentanil Infusion for Adult Burn Dressing Changes
10-29-2009
2901
Snakebite/crotalid Antivenoms
09-28-2018
3556


Miscellaneous

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Alcohol Withdrawal
07-30-2015
3459
Central Venous Catheterization
12-04-2009
6319
Fever Assessment
06-27-2019
6632
Gabapentin in Post-operative Pain Management
09-29-2016
5154
Ketamine for Analgesia
12-13-2017
5648
Laparoscopy in Trauma
02-25-2016
2731
Mangled Extremity
04-28-2016
4330
Muscle Relaxants in Multimodal Pain Management
01-26-2017
4963
Necrotizing Soft Tissues Infections
09-28-2018
4214
Negative Pressure Wound Therapy
02-06-2014
2361
Neuromuscular Blocking Agents in the Adult ICU
08-02-2018
7089



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