I had to draw a bum in my patient’s notes to illustrate where a wound was, but look how atrocious it is. I’m an art failure.
- 5 months ago
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.
we are blessed with the sweetest lab worker overnight in Pathology, and I always try to send her treats & notes to say thank you for her help - she works alone & can get pummelled with tests from ICU & Emergency.
the other morning at 4am we had to urgently get up a lot of blood products for a patient & she kindly & sweetly sent it all up like it was no trouble. I didn’t have any treats to send her at the time, so sent her some kitkats in the chute & this was her reply :)
- 9 months ago
so this happened last night…
Australia has lots of snakes that can kill you, and the venom works in very interesting ways - aside from causing paralysis that can stop your muscles of respiration so you stop being able to breathe, snake venom makes your blood use up all it’s clotting factors. the risk then is not actually dying from a clot, but dying from bleeding - you’re left with nothing to help the blood clot, so even a small injury can bleed (the major issue being if you start to bleed in your brain you can promptly die).
Antivenoms are made from horse antibodies - venom is given to horses who produce antibodies that bind the venom, and those antibodies are isolated from the horse’s bold to give to humans.
Thanks horses. Thorses.
- 11 months ago
Last night I unexpectedly (& accidentally) overdosed my patient on opiates OOPS. At least he got a good sleep & had no pain.
I’d been giving him drugs & gave him a bit extra before I moved him in bed, told him I’d be back in a couple of minutes. When I came back he wouldn’t wake up, had dropped his O2 sats, and had pinpoint pupils.
I just gave him oxygen, opened up his airway & left him be - one of the benefits of having your patient monitored in ICU is that you can have things like that happen & you don’t need to panic about it.