Practice Management Guidelines

Our primary mission is to provide excellent, patient-centered care to the acutely ill and injured. We do this in a clinical learning environment based on the best available evidence from current surgical textbooks, peer reviewed journals, and professional organizations. These practice management guidelines are meant to guide clinicians in daily medical decision-making while minimizing unwarranted variations in care and identifying knowledge gaps for future study or research endeavors.

Guidelines are developed using the GRADE methodology (GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924).

• Level 1 – Prospective randomized-controlled trial
• Level 2 – Prospective clinical study or retrospective analysis of reliable data
• Level 3 – Retrospective data including case reports or expert opinion

Furthermore, the strength of each recommendation is given a letter A – D using a process from the US Preventative Services Task Force. This categorizes the ‘certainty’ or ‘magnitude’ of benefit from the recommendation. The letter I is assigned if insufficient evidence exists to comment about the risk or benefit associated with the intervention.

Other verified trauma centers and some of our most trusted mentors were valuable resources when this project was developed in 2010. Guidelines will undergo regular review to assure the content remains current. As with any guideline, we cannot possibly address all possible scenarios. Sound clinical judgement remains vital to achieve optimal outcomes.

Trauma

Head & Neck Injury

• Blunt Cerebrovascular Injury
• Penetrating Neck Injury
• Severe Traumatic Brain Injury
• Acute Spinal Cord Injury

Thoracic

• Rib Fracture Management
• Blunt Cardiac Injury
• Thoracic Aortic Injury
• Penetrating Mediastinal Injury

Abdominal

• Penetrating Thoracoabdominal Trauma
• Penetrating Abdominal Trauma
• Blunt Abdominal Trauma
• Pancreatic Injury Trauma
• AAST Grading Of Organ Injury

Genitourinary

• Content pending

Extremity Vascular Injury

• Content pending

Musculoskeletal

• Pelvic Fracture Pathway
• Orthopedic Injury

Thermal Injury

Venous Thromboembolism Therapy

• Hematologic/Pharmacologic Therapy

Critical Care

Neurologic

• Trauma and SICU Sedation & Delirium
• Trauma and SICU Analgesia
• Alcohol & Hypnosedative Withdrawal
• Determination Of Brain Death

Cardiovascular

• Management Of Atrial Fibrillation
• Hypertension
• Vasopressors And Inotropes In Shock
• Noninvasive Hemodynamic Monitoring

Pulmonary

• Ventilator-Associated Pneumonia
• Evaluation And Management Of Hypoxia
• Evaluation And Management Of Hypercarbia
• Inhalation Injury
• Tracheostomy
• General Airway Management Guideline
• Emergency Airway Management

Gastrointestinal

• Abdominal Compartment Syndrome
• Gastroinestinal Prophylaxis
• Nutritional Support In The SICU
• Periprocedural Fasting Guidelines

Renal

• Acute Kidney Injury
• Approach To Non-Gap Metabolic Acidosis
• Electrolyte Replacement

Hematologic

• Heparin Infusion For Therapeutic Anticoagulation
• Anticoagulation Reversal
• Venous thromboembolism therapy

Infectious Disease

• Evaluation Of Fever
• Antimicrobial Use For Acute Care Surgery

Emergency General Surgery

• Small Bowel Obstruction
• Diverticulitis
• Appendicitis
• Cholecystitis
• Large Bowel Obstruction
• Necrotising Soft Tissue Infection