FASTHUGS BID Flashcards
F in FASTHUGS BID
Feeding
A in FASTHUGS BID
Analgesia
S in FASTHUGS BID (the first S)
Sedation
T in FASTHUGS BID
Thromboembolism prophylaxis
H in FASTHUGS BID
Head of bed
U in FASTHUGS BID
Ulcer prophylaxis
G in FASTHUGS BID
Glycemic control
S in FASTHUGS BID (the second S)
Spontaneous breathing trial
B in FASTHUGS BID
Bowel regimen
I in FASTHUGS BID
Indwelling catheters
D in FASTHUGS BID
De-escalation of ABX
Importance of feeding
malnutrition can lead to impaired immune function → increased susceptibility to infection, impaired wound healing, bacterial overgrowth in the GI tract and an increased risk for development of decubitus ulcers → feeding should be considered as soon as the patient is clinically stable
Considerations for feeding
Enteral > parenteral: if the gut works, use it, but parenteral nutrition may become necessary if gut isn’t working or enteral feeds aren’t tolerated
What feeds/diet is the patient receiving and can it be optimized?
Does the patient need to be NPO? If the patient is going to remain NPO for a longer period of time, should TPN be considered? (≥7 days NPO)
Importance of analgesia
providing adequate analgesia optimizes patient comfort and minimizes the acute stress response, hypermetabolism, increased oxygen consumption, hypercoagulability, and alterations in immune function. In addition, can reduce the risk of developing agitation
Considerations for analgesia
Type of pain- nociceptive vs. neuropathic: helps to choose best agent to relieve pain
Duration of pain- helps us determine whether we need long-acting agents or PRN boluses for situational pain
Account for home pain regimens: make sure underdosing isn’t occurring in patients that receive high doses at home
Common pain meds used in the ICU
Fentanyl, hydromorphone, morphine, oxycodone
Sedation considerations
RASS goals should be determined by the healthcare team and communicated to each member to ensure optimal use of sedative agents (to prevent under or oversedation)
Goal of 0 to -2 for most situations
Preferred sedative agents
Propofol, Precedex
Considerations for thromboembolism prophylaxis
VTE prophy should be given to ALL PATIENTS IN THE ICU
Initiation of appropriate prophy should be dependent on both VTE and bleed risk
Options for thromboembolism prophy
LMWH (enoxaparin 40mg SQ QD, 30mg SQ BID)
Unfractionated heparin in patients with renal dysfunction (5000 units SQ q8h)
High bleed risk: mechanical (nonpharm) prophy with graduated compression stockings or intermittent compression devices should be initiated
Combination of mechanical and pharmacological prophy can be initiated in high risk VTE patients
Importance of VAP prophy (head of bed)
Elevating the head and thorax above the bed to a 30-45 degree angle reduces occurrence of GI reflux and nosocomial pneumonia in patients who are receiving mechanical ventilation
VAP prophylaxis treatment
Maintain head of bed elevated at 30-45 degrees
Apply antiseptic mouthwash (chlorhexidine 0.12%) topically to the oral cavity TID to maintain patients’ oral hygiene to prevent bacterial growth with the endotracheal tube
Importance of ulcer prophylaxis
critically ill patients develop stress-related mucosal damage (SRMD), potentially leading to clinically significant bleeding
Major risk factors for GI bleeding
Need one of the following to require prophy:
Mechanical ventilation >48 hours OR
Coagulopathy: INR >1.5, PTT >2x ULN, platelets <50K/mm^3
Minor risk factors for GI bleeding
Need at least 2 of the following to require prophy:
Drugs that increase the risk of bleed: steroids, warfarin, heparin
Shock/sepsis/hypotension/vasopressors
Hepatic/renal failure
Multiple trauma
Burns >35% total BSA
Organ transplant
Head or spinal trauma
Hx of upper GI bleeding or PUD
Stress ulcer prophy treatment
PPIs (ex: Protonix 40mg QD), H2RAs (famotidine)
Continue until risk factors have resolved
Importance of glycemic control
Hyperglycemia is common in critically ill patients (even without a history of DM) due to multiple factors such as stress and medications (steroids, beta-blockers, vasopressors), exogenous glucose (TPN)
Proper glycemic control is necessary in critically ill patients to decrease the incidence of complications such as decreased wound healing and increased infection risk
BG level goal in ICU patients
140-180mg/dl
What is the purpose of a SBT?
SBT is performed on patients on mechanical ventilation and assesses the patient’s ability to breathe on minimal or no ventilatory support and is designed to assess whether the patient’s respiratory mechanics are favorable enough to consider liberation from mechanical ventilation
How often should a SBT be done?
Daily
Considerations for a bowel regimen
Important to monitor a patient’s bowel movements at least QD and if constipation occurs, provide them with a bowel regimen
In addition, patients receiving a lot of opioid medications, one should consider preemptively placing them on a bowel regimen
Diarrhea can occur in the ICU for various reasons and should also be paid attention to: infection, feeds, aggressive bowel regimen
Agents for bowel regimens
Options: docusate, sennosides, PEG for standing orders; bisacodyl suppositories, enemas, mag citrate for rescue options
Indwelling catheters: peripheral venous catheter
placed into a peripheral vein for venous access to administer IV therapy
Indwelling catheters: central venous catheter
lines that terminate in the superior vena cava, just above the right atrium
Indwelling catheters: arterial lines
placed into the lumen of an artery to provide a continuous display or accurate BP and access frequent arterial blood sampling
Indwelling catheters: Foley catheters
flexible tube that passes through the urethra and into the bladder to drain urine
Indwelling catheters: rectal tubes
soft catheter inserted into the rectum for fecal management to contain and divert fecal waste
How often should lines be assessed?
At least daily to assess for signs of infection/can be removed
Considerations for ABX de-escalation
De-escalating ABX as appropriate based on culture results
Setting appropriate ABX duration to avoid under or overuse of ABX
Providing necessary dose adjustments based on PK changes
