Tag Archives: ICU

ICU Checklist: FASTHUG MAIDENS

FASTHUG is a checklist developed by intensivists to ensure that key aspects of care are addressed during rounds.  The mnemonic FASTHUG stands for:

  • F = Feeding
  • A = Analgesia
  • S = Sedation
  • T = Thromboembolic prophylaxis
  • H = HOB elevation
  • U = Stress ulcer prophylaxis
  • G = Glucose control

This checklist however, does not address pharmacotherapy issues, and has been modified by clinical pharmacists to FASTHUG-MAIDENS.  FASTHUG as above, except for H which was changed to mean Hyperactive or hypoactive Delirium.  MAIDENS stands for:

  • Medication reconciliation
  • Antibiotics 
  • Indications for meds
  • Drug dosing
  • Electrolytes, Hematology and other lab tests
  • No drug interactions, allergies, duplication or side effects
  • Stop dates

 

Reference:

Masson, Sarah C et al. “Validity Evidence For FASTHUG-MAIDENS, A Mnemonic For Identifying Drug-Related Problems In The Intensive Care Unit”. The Canadian Journal of Hospital Pharmacy 66.3 (2013).

ICU Liberation – the ABCDE bundle / SAT and SBT

The ABCDE Bundle: Tools for Implementation

  • “Wake Up and Breathe” Protocol
  • Confusion Assessment Method for the ICU (CAM‐ICU) Flowsheet
  • Intensive Care Delirium Screening Checklist (ICDSC)
  • Pediatric CAM‐ICU – Worksheet for Daily Delirium Assessment
  • Progressive Mobility Protocol
  • Exercise/Mobility Safety Screen and Therapy
  • Journal Club Exercises

 

“Wake Up and Breathe” Protocol Spontaneous Awakening Trials (SATs) + Spontaneous Breathing Trials (SBTs)

Capture

 

CAM ICU Flowsheet:

Capture.JPG

REFERENCES:

http://www.icudelirium.org/docs/WakeUpAndBreathe.pdf  WakeUpAndBreathe

http://www.aacn.org/WD/CETests/Media/ABCDE–Tools%20for%20Implementation.pdf  ABCDE–Tools for Implementation

Neuromuscular Blocking Agents

Cisatracurium (Nimbex)

  • nondepolarizing neuromuscular blocker
  • metabolized by plasma ester hydrolysis and Hofmann elimination
  • best choice in both hepatic and renal dysfunction

Pancuronium

  • long acting
  • contraindicated in CAD (vagolytic effect, tachycardia)

Vecuronium

  • intermediate acting (30 minutes)
  • cleared by the kidney and liver

Rocuronium

  • rapid onset and intermediate duration
  • better choice for short procedures

Neuromuscular Blocking Agents Pediatric Emergency Medicine Practice en_a09t03

REFERENCE:

ENLS 2017 Pharmacotherapy. Neurocritical Care Journal.

Interpreting Procalcitonin Values

Units:  ng/mL (normal <0.10)

Interpretation:

1. predicting progression to severe sepsis / septic shock (taken on D1 ICU admission)

  • >2 = high risk
  • <0.5 = low risk

2. As guide to Abx therapy in respiratory infections

  • <0.1 = ABx not needed
  • >0.5 = ABx needed

PCT-Algorithms-1 PCT-Algorithms-2 PCT-Algorithms-3 PCT-Algorithms-4bild_15_pct_04_06 procalcitonin-img Procalcitonin for diagnosis Figure 2

Basics:

  • precursor of calcitonin
  • produced by parafollicular cells of thyroid gland and neuroendocrine cells of lung / intestine / other tissues in response to inflammation, esp bacterial.
  • serum values correlate with severity of sepsis, recede with improvement, worsen with exacerbation.

Test performance:

  • Bacteremia (Sn 76%, Sp 70%)
  • systemic inflammatory response syndrome (SIRS)
  • sepsis
  • septic shock.

NSUH Protocol for Management of Inpatient Hyperglycemia

Initiation of Subcutaneous InsulinInsulin Protocol

Basal and Nutritional Insulin

Insulin Protocol 02

Insulin Protocol 03

Adjustment of Insulin Dose

Insulin Protocol 04