FAST HUGS IN BED Please!

Regardless of the underlying cause of the illness, the provision of meticulous supportive care is essential to the management of any critically ill patient. Back in 2005, Jean Louis Vincent popularised the FAST HUGS mnemonic for recalling the key issues to review when looking after a critically ill patient.

Give your patient a fast hug (at least) once a day.

Vincent JL. Crit Care Med. 2005

This was subsequently updated to ‘FAST HUGS BID‘ by Vincent and Hatton:

  • Feeding/fluids
  • Analgesia
  • Sedation
  • Thromboprophylaxis
  • Head up position
  • Ulcer prophylaxis
  • Glycemic control
  • Spontaneous breathing trial
  • Bowel care
  • Indwelling catheter removal
  • Deescalation of antibiotics

Vincent WR 3rd, Hatton KW. Critically ill patients need “FASTHUGS BID” (an updated mnemonic). Crit Care Med. 2009 Jul;37(7):2326-7; author reply 2327.

I thought I’d share with you my own slightly more comprehensive version, ‘FAST HUGS IN BED Please‘, which applies equally well in the emergency department or the intensive care unit:

  • Fluid therapy and feeding
  • Analgesia, Antiemetics and ADT*
  • Sedation and Spontaneous breathing trial
  • Thromboprophylaxis, Tetanus prophylaxis
  • Head up position (30 degrees) if intubated
  • Ulcer prophylaxis
  • Glucose control
  • Skin/ eye care and suctioning
  • Indwelling catheter
  • Nasogastric tube
  • Bowel care
  • Environment (e.g. temperature control, appropriate surroundings in delirium)
  • De-escalation (e.g. end of life issues, treatments no longer needed)
  • Psychosocial support (for patient, family and staff)

** ADT™ Booster, Tetanus Vaccine, Diphtheria Vaccine

Introduction to ICU Series

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

7 Comments

    • ADT: Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine Adsorbed
      ADT® Booster is used to vaccinate children (>5 years of age) and adults who have previously received at least three doses of a vaccine for primary immunisation against diphtheria and tetanus

  1. For the ICU in Low settting , Haiti where i’m working is very important still have Tetanus with opistotonos.
    Thank you for adding .

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