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
3696
Axillary Artery and Vein Cannulation
07-29-2015
4295
Blunt Cardiac Trauma
09-28-2016
1895
Free Flap Management
03-04-2018
374
Hypertension Management
11-25-2015
3478
Noninvasive Hemodynamic Monitoring
09-28-2016
1950
Vasopressors and Inotropes in Shock
04-19-2011
23565


Endocrine

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Critical Illness-Related Corticosteroid Insufficiency
03-02-2015
1683
Hyperglycemia Control in the Critically Ill
12-06-2011
2392


Fluids/Electrolytes/Nutrition

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Electrolyte Replacement
01-14-2008
5950
Fluid Resuscitation
11-02-2017
3123
Nasogastric/Nasoenteric Tube Placement in Traumatic Craniofacial Fractures
01-25-2017
1376
Rhabdomyolysis: Prevention and Treatment
07-29-2015
1777


Gastrointestinal

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Cholecystitis
01-07-2015
2111
Acute Gastrointestinal Hemorrhage: Pharmacologic Management
12-12-2017
2473
Blunt Splenic Injury
09-29-2015
2262
Cirrhotic Management
02-24-2016
1316
Clostridium difficile Infection
06-28-2015
1853
Diverticulitis
09-29-2015
1391
Enteral Feeding Guidelines
04-09-2017
2680
Intra-abdominal Pressure Monitoring
03-22-2015
1399
Octreotide in the Prevention and Treatment of Gastrointestinal and Pancreatic Fistulas
11-02-2017
2268
Percutaneous Endoscopic Gastrostomy
06-03-2014
1033
Post-Splenectomy Vaccine Prophylaxis
07-29-2015
1408
Premature Gastrostomy / Jejunostomy Removal
10-20-2009
2417
Small Bowel Obstruction
06-03-2014
1258
Stress Ulcer Prophylaxis
11-02-2017
2263


Hematologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Blood Conservation and Transfusion Avoidance Strategies in the Surgical Patient
10-24-2009
1120
Deep Venous Thrombosis Prophylaxis in the Critically Ill
01-29-2014
3287
Disseminated Intravascular Coagulation
04-09-2017
975
DVT Prophylaxis in Solid Organ Injury
12-04-2013
1304
Erythropoietin Use in the Critically Ill
02-05-2008
2325
Factor VIIa (Recombinant) (Novoseven®) in Trauma
09-02-2008
1602
Heparin Induced Thrombocytopenia
09-04-2013
1306
Inferior Vena Caval Filter Use in Patients at High Risk for Pulmonary Embolism
10-27-2009
1301
Massive Transfusion Protocol for Hemorrhagic Shock
11-02-2017
10993
Non-Vitamin K Anticoagulation Reversal
03-29-2016
1627
Thromboelastography (TEG) in Trauma
12-03-2014
2108
Venous Thromboprophylaxis in Obesity
02-24-2016
6562
Warfarin Dosing
08-31-2009
1929
Warfarin Reversal
11-29-2017
2154


Infectious Disease

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Aerosolized Antibiotic Therapy in the ICU
03-29-2016
1268
Antibiotic Prophylaxis in Surgery
11-29-2013
6122
Ascorbic Acid in Sepsis
03-31-2018
Candida Infections in Surgical Patients
04-09-2017
3048
Continuous Antibiotic Infusions
05-15-2007
1107
Empiric Antibiotic Use in Critically Ill Patients
05-08-2007
3297
Presumptive Chest Tube Antibiotics
03-06-2013
1477


Neurologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Spinal Cord Injury Guideline
12-10-2015
2268
Antiplatelet Agent Reversal in Adults With Traumatic Intracranial Hemorrhage
04-09-2017
8884
Blunt Cerebrovascular Injury
09-29-2015
2095
Brain Death Determination / Apnea Test Procedure
09-29-2015
2573
Cervical Spine Clearance
12-12-2017
1601
Delirium Management in the ICU
01-04-2011
1471
Hypertonic Saline Solution Instructions
05-06-2008
1648
Methylprednisolone (Solumedrol) in Acute Spinal Cord Injury
08-01-2014
4692
Pain Management in Surgery
09-29-2015
1717
Sedation and Agitation Management in the ICU
10-24-2009
1525
Seizure Prophylaxis in Traumatic Brain Injury
07-31-2017
12336
Severe Traumatic Brain Injury Management
05-04-2017
3705
Syncope Evaluation in the Trauma Patient
09-28-2016
1147
Therapeutic Hypothermia
02-24-2016
1353


Respiratory

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Air Travel Following Traumatic Pneumothorax
03-19-2015
1399
Chest Tube Management
09-28-2016
1685
Extubation and the Open Abdomen
01-25-2017
1187
High frequency oscillatory ventilation in the surgical patient
03-03-2009
1203
Independent Lung Ventilation
12-03-2014
1040
Multi-modality Rib Fracture Management
11-30-2010
2085
Paracostal Infusion of Bupivacaine for Management of Rib Fracture Pain
04-20-2010
2336
Peri-Procedural Tracheostomy Complications
01-03-2013
1052
Post-Extubation Stridor
07-31-2017
3958
Post-Tracheostomy Hemorrhage
07-29-2015
1550
Retained Hemothorax
04-27-2016
3245
Surgical Fixation of Rib Fractures
02-06-2013
7608
Timing of Tracheostomy
09-29-2015
2193
Tissue Plasminogen Activator in Traumatic Hemothorax
03-31-2018
1138
Ventilator-Associated Pneumonia
02-24-2016
1491


Skin

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Burn Resuscitation
12-04-2013
1402
Ascorbic Acid Infusion (Vitamin C) Infusion in the Resuscitation of Burn Patients
11-29-2013
1234
Ketamine Sedation for Adult Burn Dressing Changes
12-06-2013
2427
Perioperative Hypothermia Prevention in Burn Patients
03-31-2018
Remifentanil Infusion for Adult Burn Dressing Changes
10-28-2009
1359
Snakebite/crotalid Antivenoms
11-30-2010
1254


Miscellaneous

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Alcohol Withdrawal
07-29-2015
1467
Central Venous Catheterization
12-03-2009
3525
Fever Assessment
01-30-2013
2041
Gabapentin in Post-operative Pain Management
09-28-2016
3036
Ketamine for Analgesia
12-12-2017
1068
Laparoscopy in Trauma
02-24-2016
1287
Mangled Extremity
04-27-2016
1673
Muscle Relaxants in Multimodal Pain Management
01-25-2017
1392
Necrotizing Soft Tissues Infections
06-03-2014
1166
Negative Pressure Wound Therapy
02-05-2014
1031
Neuromuscular Blocking Agents in the Adult ICU
11-08-2013
2352



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