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
6674
Axillary Artery and Vein Cannulation
07-30-2015
8010
Blunt Cardiac Trauma
09-29-2016
3405
Free Flap Management
03-05-2018
2331
Hypertension Management
11-26-2015
7486
Noninvasive Hemodynamic Monitoring
09-29-2016
3370
Resuscitative Balloon Occlusion of the Aorta (REBOA)
08-12-2018
1912
Vasopressors and Inotropes in Shock
04-20-2011
26072


Endocrine

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Critical Illness-Related Corticosteroid Insufficiency
03-03-2015
2962
Hyperglycemia Control in the Critically Ill
12-07-2011
4756
Thyroid Management in the ICU
06-18-2019
574


Fluids/Electrolytes/Nutrition

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Electrolyte Replacement
08-12-2018
12342
Fluid Resuscitation
11-03-2017
5908
Nasogastric/Nasoenteric Tube Placement in Traumatic Craniofacial Fractures
01-26-2017
3725
Rhabdomyolysis: Prevention and Treatment
08-12-2018
5570


Gastrointestinal

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Cholecystitis
01-08-2015
3975
Acute Gastrointestinal Hemorrhage: Pharmacologic Management
12-13-2017
4866
Blunt Splenic Injury
09-30-2015
3764
Cirrhotic Management
02-25-2016
2415
Clostridium difficile Infection
06-29-2015
3210
Diverticulitis
09-30-2015
2450
Enteral Feeding Guidelines
04-10-2017
6768
Intra-abdominal Pressure Monitoring
03-23-2015
2489
Octreotide in the Prevention and Treatment of Gastrointestinal and Pancreatic Fistulas
11-03-2017
8402
Percutaneous Endoscopic Gastrostomy
06-04-2014
1849
Post-Splenectomy Vaccine Prophylaxis
01-27-2019
3431
Premature Gastrostomy / Jejunostomy Removal
10-21-2009
4303
Small Bowel Obstruction
06-04-2014
2273
Stress Ulcer Prophylaxis
11-03-2017
4153


Hematologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Blood Conservation and Transfusion Avoidance Strategies in the Surgical Patient
06-27-2019
2285
Deep Venous Thrombosis Prophylaxis in the Critically Ill
01-30-2014
5713
Disseminated Intravascular Coagulation
04-10-2017
1851
DVT Prophylaxis in Solid Organ Injury
12-05-2013
2222
Erythropoietin Use in the Critically Ill
02-06-2008
3879
Factor VIIa (Recombinant) (Novoseven®) in Trauma
09-03-2008
2413
Heparin Induced Thrombocytopenia
09-05-2013
2191
Inferior Vena Caval Filter Use in Patients at High Risk for Pulmonary Embolism
10-28-2009
2278
Massive Transfusion Protocol for Hemorrhagic Shock
11-03-2017
22960
Non-Vitamin K Anticoagulation Reversal
08-12-2018
3338
Thromboelastography (TEG) in Trauma
12-04-2014
3935
Venous Thromboprophylaxis in Obesity
02-25-2016
10451
Warfarin Dosing
09-01-2009
2871
Warfarin Reversal
11-30-2017
3764


Infectious Disease

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Aerosolized Antibiotic Therapy in the ICU
03-30-2016
2246
Antibiotic Prophylaxis in Surgery
11-30-2013
9632
Candida Infections in Surgical Patients
04-10-2017
3996
Continuous Antibiotic Infusions
05-16-2007
1918
Empiric Antibiotic Use in Critically Ill Patients
05-09-2007
4595
Facial Fracture Antibiotics
06-27-2019
403
Presumptive Chest Tube Antibiotics
03-07-2013
2334


Neurologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Spinal Cord Injury Guideline
09-11-2018
6885
Antiplatelet Agent Reversal in Adults With Traumatic Intracranial Hemorrhage
04-10-2017
22686
Blunt Cerebrovascular Injury
09-30-2015
3263
Brain Death Determination / Apnea Test Procedure
09-30-2015
4466
Cervical Spine Clearance
12-13-2017
2892
Delirium Management in the ICU
08-12-2018
4324
Hypertonic Saline Solution Instructions
05-07-2008
2715
Methylprednisolone (Solumedrol) in Acute Spinal Cord Injury
08-02-2014
6022
Pain Management in Surgery
09-30-2015
2754
Sedation and Agitation Management in the ICU
10-25-2009
2742
Seizure Prophylaxis in Traumatic Brain Injury
08-01-2017
25940
Severe Traumatic Brain Injury Management
06-27-2019
6534
Syncope Evaluation in the Trauma Patient
09-29-2016
2034
Therapeutic Hypothermia
02-25-2016
2346


Respiratory

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Air Travel Following Traumatic Pneumothorax
03-20-2015
2389
Chest Tube Management
09-29-2016
3300
Diaphragm Pacing
07-18-2019
249
Extubating the Trauma Patient with an Open Abdomen
06-24-2018
1446
High frequency oscillatory ventilation in the surgical patient
03-04-2009
2045
Independent Lung Ventilation
12-04-2014
1876
Multi-modality Rib Fracture Management
12-01-2010
3627
Paracostal Infusion of Bupivacaine for Management of Rib Fracture Pain
04-21-2010
3772
Peri-Procedural Tracheostomy Complications
01-04-2013
1804
Post-Extubation Stridor
08-01-2017
4944
Post-Tracheostomy Hemorrhage
07-30-2015
2864
Rescue Ventilation
08-22-2018
1950
Retained Hemothorax
04-28-2016
6057
Surgical Fixation of Rib Fractures
02-07-2013
8811
Timing of Tracheostomy
09-30-2015
3764
Tissue Plasminogen Activator in Traumatic Hemothorax
04-01-2018
2812
Ventilator-Associated Pneumonia
02-25-2016
2403


Skin

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Burn Inhalation injury
06-18-2019
523
Burn Resuscitation
06-18-2019
3074
Ketamine Sedation for Adult Burn Dressing Changes
12-07-2013
3415
Perioperative Hypothermia Prevention in Burn Patients
04-01-2018
3069
Remifentanil Infusion for Adult Burn Dressing Changes
10-29-2009
2366
Snakebite/crotalid Antivenoms
09-28-2018
2932


Miscellaneous

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Alcohol Withdrawal
07-30-2015
2675
Central Venous Catheterization
12-04-2009
5496
Fever Assessment
06-27-2019
4470
Gabapentin in Post-operative Pain Management
09-29-2016
4521
Ketamine for Analgesia
12-13-2017
3730
Laparoscopy in Trauma
02-25-2016
2130
Mangled Extremity
04-28-2016
3390
Muscle Relaxants in Multimodal Pain Management
01-26-2017
3827
Necrotizing Soft Tissues Infections
09-28-2018
2979
Negative Pressure Wound Therapy
02-06-2014
1849
Neuromuscular Blocking Agents in the Adult ICU
08-02-2018
5547



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