The Doctor’s Alphabet and the FAST HUG.

Now first of all I would like to apologise for being a little bit late on my last two blogs…admittedly I am a week behind. In my defence, it has been a hectic time both in work and personally, so I lost track of time. Anyway, basking in the success of the England win over Wales in the rugby I thought I would talk about how learning the alphabet in intensive care and ‘fast-hug’ have revolutionised the way I see any new patient.

Now this first concept I want to share with you is about one thing – not missing anything. In the heat of assessing any patient – whether it be acutely in accident and emergency or in a controlled ward environment – things can be missed. Missed components to any patient are dangerous because it may very well be the missing link (no pun intended…well, maybe just a little bit intended..). So let me run you through the doctor alphabet letter by letter..

A – stands for Airway – is the patient’s airway secure

This is important because if it isn’t then this will kill them very very quickly

B – stands for Breathing – is the patient breathing and how well

This is important because if they are breathing too quickly or not enough it can hint to a problem

C – stands for Circulation – what is the patient’s heart rate, blood pressure, urination etc

This is important because problems here can suggest all manner of problems with the heart or blood

D­ – stands for Disability – this is neurological disability – is the patient talking, moving their limbs etc

This is important because problems here suggest a brain or brain-related problem

E – stands for Electrolytes – what is the patient’s sodium and potassium blood levels

This is important because deficiencies or excesses can cause fatal heart rhythms as an example

F – stands for Fluid Balance – what is the amount of fluid going into the patient vs. how much out

This is important because fluids excess can flood the lungs, and deficiency can drop blood pressure

G – stands for Glucose – what is the blood sugar level

This is important because a low blood sugar can cause neurological symptoms and coma

H – stands for haemoglobin – what is the red blood cell count in the body

This is important because a drop, may for example, suggest an bleed somewhere in the body

I – stands for Infection – what is the body temperature, white blood cell count and any antibiotics

This is important because it summarises if this patient is fighting an infection – established or new

So there you have it – if you approach any patient with the A-I alphabet approach then you will, as a doctor, rarely (or at the very least, less likely) to miss any major parameter. Trust me it really works! In fact when I am asked to assess a patient, the first thing I do is take a sheet of clinical note paper and write the letters down the side of the sheet!

So with all that said, what on earth is FAST-HUG about?! Well, it is a lovely little acronym that I learned in intensive care that just allows  the doctor to not miss any of the more peripheral factors that can so often be over-looked in light of the more serious A-I factors. So, without further delay, let me share with you FAST-HUG:

F – stands for Feed – i.e. how are we feeding this patient? Orally, enterally or parenterally?

A – stands for Analgesia – i.e. how are we managing this patient’s pain? Paracetamol? Morphine?

S – stands for Sedation – (more for ITU setting) but how are we sedating this patient?

T – stands for Thromboprophylaxis – i.e. how are we stopping the formation of blood clots?

H – stands for Head Tilt – i.e. has the patient got their head tilted by at least 30 degrees?

U – stands for Ulcer Prophylaxis – i.e. are we protecting against stomach ‘stress’ ulcers?

G – stands for Glucose – i.e. what is the blood sugar (the most over-looked measurement!)

And with that, I will leave you to digest the thought that next time you see a doctor in Accident and Emergency, there is a high chance that the doctor will be running through the alphabet in their head!

Have a great week.

Dr Nick

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