I just sent a text to one of the guys in the year below me the basics of the FASTHUG principal for “ICU Prophylaxis”, or preventing common problems in ICU patients, so I thought of post it in case any like minded student types want a quick & easy guide (just keep in mind I’m in Australia, so things may be a little different in other countries).
So, what does it stand for?
Head of bed 30°
Ulcer prophylaxis (PPIs)
F) feed people as soon as you can, if you can’t feed them enterally (oral/NG) start TPN. consult with Dieticians!
A) keep pts pain free (pretty simple!), utilise the Pain Team! they’re a branch of anaesthetics & they love being consulted
S) sedation gets a bit controversial; some bosses like patients to take “sedation vacations” during the day as it decreases ICU stay length. as for choice - propofol is very short acting, so good for short term or if you need to assess GCS more frequently. midaz hangs around much longer, so bad if you’re planning on waking up & extubating the next day.
T) clexane/heparin + TEDS + calf compressors on EVERYONE unless contraindicated. mobilise early & often, consult with Physios!
H) pretty simple!
U) 40mg pantoprazole IV daily
G) check sugars regularly (esp when starting feeds, always when on TPN). start an actrapid sliding scale for diabetics until they are more stable (typically 0.5units per mmol of sugar, if the sugar is over 6 - eg. if it’s 5, give nothing. if it’s 8, give 4units). actrapid infusions for persistently high sugars & DKA.