Intro and FAST HUGS BID Flashcards
therapeutic considerations in the critically ill- PKPD
fluid shifts, hepatic dysfunction, renal dysfunction
therapeutic considerations in the critically ill- specific prophylaxis
ventilator associated pneumonia, stress ulcer prophylaxis, VTE prophylaxis
FAST HUGS BID
F: feeding
A: analgesia
S: sedation
T: thromboprophylaxis
H: head of bed (VAP prophylaxis)
U: ulcer prophylaxis
G: glycemic control
S: spontaneous breathing trial
B: bowel regimen
I: indwelling catheters
D: de-escalation of antibiotics
F: feeding importance
malnutrition can lead to impaired immune function
F: feeding considerations
emphasis on early enteral feeding, “if the gut works, use it”
A: analgesia importance
optimizes patient comfort and minimizes acute stress response
A: analgesia pain scales
critical care pain observation tool (CPOT) and behavioral pain scale (BPS)
S: sedation causes
anxiety, pain, lack of homeostasis, withdrawal, sleep-wake cycle disruption
S: sedation agents
dexmedetomidine (precedex) or propofol are preferred over BZDs
T: thromboembolism prophylaxis considerations
should be given to all patients in ICU
T: thromboembolism prophylaxis agents
-enoxaparin 40 mg SQ qd or 30 mg SQ bid
-UFH for high bleed risk
-mechanical for renal dysfunction
H: head of bed importance
ventilator associated pneumonia (VAP) prophylaxis; elevating the head and thorax reduces GI reflux and pneumonia
H: head of bed considerations
-maintain the head of the bed at 30-45*
-apply antiseptic (chlorhexidine 0.12%) mouthwash to oral cavity tid to prevent bacterial growth with tube
U: ulcer prophylaxis importance
critically ill patients develop stress-related mucosal damage (SRMD) leading to bleeding
U: ulcer prophylaxis major risk factors
1 requires prophylaxis
-mechanical ventilation >48 hrs
-coagulopathy: INR >1.5, PTT >2x ULN, or platelets <50,000/mm^3
U: ulcer prophylaxis minor risk factors
> /2 require prophylaxis
-drugs that increase bleed risk (steroids, heparin, warfarin)
-shock/sepsis/hypotension/vasopressor
-hepatic/renal failure
-multiple traumas
-burns >35% total BSA
-organ transplant
-head or spinal trauma
-hx of upper GI bleed or PUD
U: ulcer prophylaxis agents
PPI or H2RA until risk factors have resolved
G: glycemic control importance
glucose variability is associated with worse morbidity and mortality
G: glycemic control goals
maintaining blood glucose at 140-180 mg/dL
S: spontaneous breathing trial (SBT)
should be performed daily to determine extubation readiness
B: bowel regimen
monitor for constipation or diarrhea
I: indwelling catheters types
peripheral venous, central venous, arterial, foley
I: indwelling catheters importance
assess for infection and need for lines
D: de-escalation of antibiotics
de-escalate based on culture results, set appropriate duration to avoid overuse, dose adjustments based on PK changes
