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.