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.

Vincent JL. Give your patient a fast hug (at least) once a day. Crit Care Med. 2005 Jun;33(6):1225-9. Review. PMID: 15942334.

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 “FAST HUGS BID” (an updated mnemonic). Crit Care Med. 2009 Jul;37(7):2326-7; author reply 2327. PMID: 19535943.

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 (AAA)
  • Sedation and  Spontaneous breathing trial
  • Thromboprophylaxis
  • Head up position (30 degrees) if intubated
  • Ulcer prophylaxis
  • Glucose control
  • Skin/ eye care and suctioning
  • Indwelling catheter
  • Nasogastric tube
  • Bowel cares
  • 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)
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  1. nik stanley says

    nice work Nickson, there is a good ext to FASTHUG in JICS, vol 11,1, jan2010 p 69 FAITH (Fluid balance, Aperients, Investigations and results, Therapies and Hydration) by M Chickungwa but yours is excellent .
    I guess one of my bug bears is the med chart not being groomed over properly but the subcategories should ensure that this is done!
    Come back to icu soon

    • says

      Cheers Nikky

      Didn’t know about FAITH.

      Agree re: meds -- not deescalating meds in ICU is a common problem!

      My full mantra currently is:

      Systems A to G (airway, breathing, circulation, disability, exposure (incl skin, sec survey if trauma, temp), fluid/ renal, GI)
      lines, labs (and other investigations), meds, micro
      FASTHUGS IN BED Please
      Then onto the next bay!


      • Jeremy Fernando says

        Nice. I love having nice ways of remembering how to do the basics well. My ward round approach to ICU patients =

        A -- Airway
        B -- Breathing
        C -- Circulation
        D -- Disability/neurology
        E -- Exposure (temperature, sepsis, skin)
        F -- Fluid balance and renal
        G -- Gastrointestinal

        L -- Lines
        L -- Lab’s
        M -- Medication review with de-escalation
        F -- FASTHUG (which now could be expanded FASTHUG IN BED)
        F -- Family

        Bring it!


  2. Andrew Coggins says

    This is an excellent approach, I enjoyed reading it and using it in my approach to the Big ‘F’ FACEM exam

  3. George says

    Just been trying to tidy my checklist a little…
    A -- airway
    B -- breathing (input: FiO2, vent settings etc, and output: sats, PCO2, ABG
    C -- circulation: including volume status with fluid balance and vasopressors
    D -- disability: including GCS, neuro obs, sedation and analgesia
    E- environment, Temp
    F- food in and out (bowels)
    G- glucose control and other labs
    H- host defense: ADT, AB’s, micro
    H- head of bed 30 deg
    I- in dwelling lines/tubes/catheters
    J/K/L -- Just Keep Looking for pressure areas
    M- mobilization
    N-need for restraint?
    O- ok haven’t got one for this yet…
    P- prophylaxis (thrombo/ulcer)
    Q- questions from the patient or family?
    R- radiology review

    Hope that’s helpful

  4. Amy Chan-Dominy says

    Paediatric version with FAST HUG BABIES
    • Feeds & Fluids
    • Analgesia, antiemetics and anti-delirium/depressant
    • Sedation & score (COMFORT/WAT)
    • Temperature control & target
    • Head up position (30 degrees) if intubated
    • Unnecessary drugs (review for drug interactions and stop-date)
    • Glucose control
    • Bowel cares
    • Allied services (physio/OT/social/parents)
    • Bloods (limit excessive testing; review results)
    • Indwelling lines, wires & tubes for removal
    • End-of-life issues, limitations of interventions
    • Skin/ eye care