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
7349
Axillary Artery and Vein Cannulation
07-30-2015
8725
Blunt Cardiac Trauma
09-29-2016
3806
Free Flap Management
03-05-2018
2977
Hypertension Management
11-26-2015
8296
Noninvasive Hemodynamic Monitoring
09-29-2016
3767
Resuscitative Balloon Occlusion of the Aorta (REBOA)
08-12-2018
2361
Vasopressors and Inotropes in Shock
09-12-2019
27944


Endocrine

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Critical Illness-Related Corticosteroid Insufficiency
03-03-2015
3405
Hyperglycemia Control in the Critically Ill
12-07-2011
5298
Thyroid Management in the ICU
06-18-2019
1582


Fluids/Electrolytes/Nutrition

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Electrolyte Replacement
08-12-2018
14145
Fluid Resuscitation
11-03-2017
8512
Nasogastric/Nasoenteric Tube Placement in Traumatic Craniofacial Fractures
01-26-2017
4443
Rhabdomyolysis: Prevention and Treatment
08-12-2018
7317


Gastrointestinal

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Cholecystitis
01-08-2015
4489
Acute Gastrointestinal Hemorrhage: Pharmacologic Management
12-13-2017
5492
Blunt Splenic Injury
09-30-2015
4123
Cirrhotic Management
02-25-2016
2753
Clostridium difficile Infection
06-29-2015
3571
Diverticulitis
09-30-2015
2800
Enteral Feeding Guidelines
04-10-2017
7753
Intra-abdominal Pressure Monitoring
03-23-2015
2842
Octreotide in the Prevention and Treatment of Gastrointestinal and Pancreatic Fistulas
11-03-2017
9981
Percutaneous Endoscopic Gastrostomy
06-04-2014
2121
Post-Splenectomy Vaccine Prophylaxis
01-27-2019
6885
Premature Gastrostomy / Jejunostomy Removal
10-21-2009
4800
Small Bowel Obstruction
06-04-2014
2625
Stress Ulcer Prophylaxis
11-03-2017
4607


Hematologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Blood Conservation and Transfusion Avoidance Strategies in the Surgical Patient
06-27-2019
3144
Deep Venous Thrombosis Prophylaxis in the Critically Ill
01-30-2014
6255
Disseminated Intravascular Coagulation
04-10-2017
2144
DVT Prophylaxis in Solid Organ Injury
12-05-2013
2547
Erythropoietin Use in the Critically Ill
02-06-2008
4266
Factor VIIa (Recombinant) (Novoseven®) in Trauma
09-03-2008
2694
Heparin Induced Thrombocytopenia
09-14-2019
2885
Inferior Vena Caval Filter Use in Patients at High Risk for Pulmonary Embolism
10-28-2009
2578
Massive Transfusion Protocol for Hemorrhagic Shock
11-03-2017
25398
Non-Vitamin K Anticoagulation Reversal
08-12-2018
3665
Thromboelastography (TEG) in Trauma
12-04-2014
4499
Venous Thromboprophylaxis in Obesity
02-25-2016
11558
Warfarin Dosing
09-01-2009
3173
Warfarin Reversal
11-30-2017
4157


Infectious Disease

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Aerosolized Antibiotic Therapy in the ICU
03-30-2016
2477
Antibiotic Prophylaxis in Surgery
11-30-2013
10841
Candida Infections in Surgical Patients
04-10-2017
4274
Continuous Antibiotic Infusions
05-16-2007
2197
Empiric Antibiotic Use in Critically Ill Patients
05-09-2007
4966
Facial Fracture Antibiotics
06-27-2019
1308
Presumptive Chest Tube Antibiotics
03-07-2013
2597


Neurologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Spinal Cord Injury Guideline
09-11-2018
7468
Antiplatelet Agent Reversal in Adults With Traumatic Intracranial Hemorrhage
04-10-2017
23134
Blunt Cerebrovascular Injury
09-30-2015
3548
Brain Death Determination / Apnea Test Procedure
09-10-2019
5450
Cervical Spine Clearance
12-13-2017
3212
Delirium Management in the ICU
08-12-2018
5073
Hypertonic Saline Solution Instructions
05-07-2008
3039
Methylprednisolone (Solumedrol) in Acute Spinal Cord Injury
08-02-2014
6345
Pain Management in Surgery
09-30-2015
3020
Sedation and Agitation Management in the ICU
10-25-2009
3065
Seizure Prophylaxis in Traumatic Brain Injury
08-01-2017
27154
Severe Traumatic Brain Injury Management
09-11-2019
7959
Syncope Evaluation in the Trauma Patient
09-29-2016
2316
Therapeutic Hypothermia
02-25-2016
2654


Respiratory

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Air Travel Following Traumatic Pneumothorax
03-20-2015
2678
Chest Tube Management
09-29-2016
3696
Diaphragm Pacing
07-18-2019
1023
Extubating the Trauma Patient with an Open Abdomen
06-24-2018
1819
High frequency oscillatory ventilation in the surgical patient
03-04-2009
2311
Independent Lung Ventilation
12-04-2014
2114
Multi-modality Rib Fracture Management
12-01-2010
3990
Paracostal Infusion of Bupivacaine for Management of Rib Fracture Pain
04-21-2010
4122
Peri-Procedural Tracheostomy Complications
01-04-2013
2045
Post-Extubation Stridor
08-01-2017
5239
Post-Tracheostomy Hemorrhage
07-30-2015
3189
Rescue Ventilation
08-22-2018
2354
Retained Hemothorax
04-28-2016
6834
Surgical Fixation of Rib Fractures
02-07-2013
9142
Timing of Tracheostomy
09-30-2015
4122
Tissue Plasminogen Activator in Traumatic Hemothorax
04-01-2018
3223
Ventilator-Associated Pneumonia
02-25-2016
2694


Skin

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Burn Inhalation injury
06-18-2019
1462
Burn Resuscitation
11-26-2019
4168
Ketamine Sedation for Adult Burn Dressing Changes
12-07-2013
3679
Perioperative Hypothermia Prevention in Burn Patients
04-01-2018
4370
Remifentanil Infusion for Adult Burn Dressing Changes
10-29-2009
2620
Snakebite/crotalid Antivenoms
09-28-2018
3237


Miscellaneous

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Alcohol Withdrawal
07-30-2015
3036
Central Venous Catheterization
12-04-2009
5898
Fever Assessment
06-27-2019
5689
Gabapentin in Post-operative Pain Management
09-29-2016
4831
Ketamine for Analgesia
12-13-2017
4649
Laparoscopy in Trauma
02-25-2016
2379
Mangled Extremity
04-28-2016
3823
Muscle Relaxants in Multimodal Pain Management
01-26-2017
4379
Necrotizing Soft Tissues Infections
09-28-2018
3533
Negative Pressure Wound Therapy
02-06-2014
2095
Neuromuscular Blocking Agents in the Adult ICU
08-02-2018
6208



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