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    F.A.S.T.H.U.G: I W. Aryabiantara

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    arnawaiputu60
    The document outlines the FASTHUG mnemonic as a guide for ICU practitioners to provide holistic care to patients. It stands for: F- Feeding A- Analgesia S- Sedation T- Thromboembolism Prophylaxis H- Head of Bed Elevation U- Ulcer Protection G- Glucose Control The document then provides further details and guidelines for each element of care such as enteral nutrition targets, pain assessment scales, sedation goals, mechanical and pharmacological thromboembolism prophylaxis, ventilator bundle recommendations, and glycemic control targets. Adhering to this comprehensive

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    F.A.S.T.H.U.G: I W. Aryabiantara

    Uploaded by

    arnawaiputu60
    352 views35 pages
    The document outlines the FASTHUG mnemonic as a guide for ICU practitioners to provide holistic care to patients. It stands for: F- Feeding A- Analgesia S- Sedation T- Thromboembolism Prophylaxis H- Head of Bed Elevation U- Ulcer Protection G- Glucose Control The document then provides further details and guidelines for each element of care such as enteral nutrition targets, pain assessment scales, sedation goals, mechanical and pharmacological thromboembolism prophylaxis, ventilator bundle recommendations, and glycemic control targets. Adhering to this comprehensive

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    FASTHUG drArya

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    The document outlines the FASTHUG mnemonic as a guide for ICU practitioners to provide holistic care to patients. It stands for: F- Feeding A- Analgesia S- Sedation T- Thromboembolism Prophylaxis H- Head of Bed Elevation U- Ulcer Protection G- Glucose Control The document then provides further details and guidelines for each element of care such as enteral nutrition targets, pain assessment scales, sedation goals, mechanical and pharmacological thromboembolism prophylaxis, ventilator bundle recommendations, and glycemic control targets. Adhering to this comprehensive

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    352 views35 pages

    F.A.S.T.H.U.G: I W. Aryabiantara

    Uploaded by

    arnawaiputu60
    The document outlines the FASTHUG mnemonic as a guide for ICU practitioners to provide holistic care to patients. It stands for: F- Feeding A- Analgesia S- Sedation T- Thromboembolism Prophylaxis H- Head of Bed Elevation U- Ulcer Protection G- Glucose Control The document then provides further details and guidelines for each element of care such as enteral nutrition targets, pain assessment scales, sedation goals, mechanical and pharmacological thromboembolism prophylaxis, ventilator bundle recommendations, and glycemic control targets. Adhering to this comprehensive

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 35

    F.A.S.T.H.U.

    G
    I W. Aryabiantara

    F.A.S.T.H.U.G
    Its a mnemonic memudahkan seorang
    praktisi medis dalam memberikan terapi
    (Jean-Louis Vincent)
    F = Feeding
    A = AnalgetiK
    S = Sedasi
    T = tromboemboli profilaksis
    H = Head of bed elevasi
    U = Ulcer proteksi
    G = Glucouse kontrol

    FEEDING
    Berikan nutrisi se-segera mungkin
    setelah resusitasi stabil
    Ideal <72 jam
    Nutrisi dini menurunkan angka
    kematian secara signifikan
    Bisa enteral bisa parenteral

    Postprandial Hypotension
    500
    700
    C

    Liver

    vasodilatation

    200
    400

    Stomach
    Spleen
    Meal

    1000

    Decrease Venous Return


    decrease Stroke Volume
    decrease Blood Pressur
    VASODILATATION

    Pancreas

    500
    S

    Aorta

    300
    I

    Small
    intestine
    Colon

    From Review of medical physiology, Ganong WF.


    2001

    Hepatic
    Portal
    vein

    LOW FLOW STATE / HAEMORRHAGIC


    SHOCK
    Shock state

    NORMAL

    Control of
    CV system

    Spinchter
    closed

    Vasoconstriction

    DIVERTED BLOOD FLOW


    HEART & BRAIN

    DIVERTED BLOOD SUPPLY


    HEART & BRAIN

    G
    FEEDING
    N
    I
    D
    E
    FE

    The gut-origin hypothesis


    Cardiac failure:

    Hypovolaemia:
    - Dehydration
    - Hemorrhage

    Endogenous vasoconstrictor

    Splanchnic Hypoperfusion

    AMI
    CHF
    Tamponade

    Exogenous
    vasoconstrictor:
    NE, Epi, Dopa

    Resuscitation

    Gut mucosal hypoperfusion

    Ischaemia-Reperfusion injury
    1. Gut mucosal barrier disruption
    Increased mucosal permeability
    to bacteria / endotoxin

    Cytokine/RO
    S

    SIRS

    MODS

    Gareth Ackland, Michael PW Grocott and Michael G Mythen: Crit Care 2000, 4:269281

    ANALGESIA
    Dasar : nyeri adalah vital sign yang ke-5
    Pasien dalam kondisi apapun tidak boleh
    nyeri
    Rangsangan nyeri tersebut dapat
    mempengaruhi pemulihan fisiologis dan
    psikologis kurang tidur, disfungsi paru
    dan respon stres imunosupresi,
    hiperkoagulabilitas, katabolisme protein
    dan meningkatkan oksigen miokard
    consumption

    Source of Pain in
    ICU

    Repeated episodes of acute pain, localised

    Surgery / tissue inflammation / immobility

    Catheter/ apparatus discomfort / naso &


    orogastric tubes

    Endotracheal intubation/ suctioning/ chest


    tubes

    Phlebotomy / vascular access /


    physiotherapy

    Routine turning & positioning the patient

    n da
    o
    i
    t se
    a
    b ly
    on
    e

    n
    o
    i
    t

    d
    an

    la
    re

    n
    xa

    c
    Lo

    c
    Lo

    a
    l
    a

    th
    s
    e

    ic
    t
    e

    m
    so

    a
    l
    a

    im
    t
    e

    es

    st
    e
    n

    ic
    t
    e

    so

    e
    iv
    t
    ec
    f
    ne

    im
    t
    e

    es

    e
    iv
    t
    ec
    f
    ne

    e
    Th

    u
    nf
    i
    pa
    t
    os
    m

    o
    R
    .
    ll.

    e
    in
    t
    u

    r
    tu

    ng
    i
    n

    was normal

    c
    e
    R

    ng
    i
    v
    ei

    ta
    e
    B

    er
    k
    o
    Bl

    Assessment of
    pain
    in
    ICU
    Critical clinical practice guidelines;
    pain assesment and response to therapy should be

    performed on a regular basis using a scale


    appropriate to the patient population.
    The use of VAS and NRS is recommended
    For patients who cannot communicate, pain should

    be assessed through subjective observation of;


    Pain related behaviour
    Physiological indicators

    Assessment of
    pain in ICU Pain Rating Scale
    Visual Analogue
    Scale
    Numeric Rating
    Scale
    Faces Scale
    McGill Pain
    Questionnare

    Assasement nyeri

    Pharmacologic Management
    of pain in the ICU

    Textbook critical care, M. Fink 2006

    an
    t
    n
    Fe

    o
    G
    :
    yl

    n
    e
    ld

    rd
    a
    nd
    a
    St

    rH
    o
    f

    y
    od
    em

    y
    lit
    i
    ab
    t
    s
    ic
    m
    na

    SEDASI

    TROMBOEMBOLI PROFILAKSIS

    Cara Mekanik :
    Perubahan posisi berbaring secara
    berkala,
    Pijat rutin pada tungkai bawah
    Early mobilisasi pada pasien sadar
    Graduated compression stockings
    (GCS),
    Intermittent pneumatic compression
    (IPC) devices
    Venous foot pump (VFP).

    Terapi medikamentosa :
    dapat berupa Heparin 5000 Unit
    setiap 8 jam
    Enoxaparin 30 Unit setiap 12 jam
    Dalteparin 2500 - 5000 Unit setiap 24
    jam
    Fondaparinux 2,5 mg setiap 24 jam

    Head of The Bed Up


    Kemiringan bed 45 derajat
    Mencegah regurgitasi
    Salah satu komponen bundle
    pencegahan VAP
    Pressure cuff dijaga < 20 mmHg
    Sub glotic suction, oral hygiene

    ULCER PROTEKSI
    H2 Antagonists seperti Cimetidine 300
    mg oral atau IV setiap 6-8 jam
    Famotidine 20 mg oral atau IV setiap 12
    jam,
    Ranitidine 50 mg IV setiap 12 jam
    Penghambat pompa proton seperti
    Lanzoprazole 30 mg setiap 24 jam,
    omeperazole 20 mg setiap 24 jam atau
    Pantoprazole 40 mg setiap 24 jam,
    Sucralfat 10 mg setiap 6 jam

    Glucosa Control
    -Hyperglicemia meningkatkan morbiditas,
    mortalitas dan biaya perawatan.
    -Dengan mengontrol gula darah akan
    menurunkan insidens penyembuhan luka
    yang lama, resiko infeksi, gangguan
    motilitas usus, gangguan performa
    kardiovaskuler, resiko polineuropati dan
    resiko gagal ginjal akut.

    - Target gula darah idealnya


    dipertahankan dilevel 140-180 mg/dL.
    -Strategi mempertahankan gula darah :
    Insulin continuous dapat dijalankan
    setelah 2 kali pemeriksaan dengan
    interval 1 jam, masih menunjukkan >
    180 mg/dL (kadang-kadang memerlukan
    insulin bolus sebelumnya). Insulin yang
    digunakan yg short acting
    Hindari penggunaan sub kutan jika
    hemodinamik pasien belum stabil

    Ventilator Bundle

    Patient positioning Elevation


    Recommended elevation is 30-45
    degrees
    Ventilator weaning Periodic sedative
    interruptions and daily assessment
    of readiness to extubate may reduce
    the duration of mechanical ventilation
    and the risk of VAP

    ICU Bundle
    Peptic ulcer disease (PUD) prophylaxis
    Patients with respiratory failure have an
    increased risk of stress ulcers and
    associated gastrointestinal (GI) bleeding.
    Venous thromboembolism prophylaxis
    Patients with respiratory failure have an
    increased risk of deep vein thrombosis.
    Treatment with anticoagulants (e.g.,
    heparin) has been shown to reduce this
    risk.

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