Mnemonics help us in memorizing. In the intensive care unit (ICU), FASTHUG is a very commonly used mnemonic that helps us in daily care of patients admitted to the ICU.1 We wish to submit another easy acronym “HEAD INJURY” which will help the ICU staff and doctors to memorize specific considerations in patients who have been admitted to ICU with a diagnosis of severe head injury. Here are the components of this mnemonic: H (head end elevation) – The head end of the patients should be elevated to 30°–45°. This lowers intracranial pressure (ICP) by enhancing cerebral venous drainage. E (eptoin) – Eptoin or other antiepileptics (e.g., levetiracetam) are used to decrease the incidence of early posttraumatic seizures. A (analgesia) – Pain and agitation cause increased ICP. Hence, head injury patients who are on ventilators should be administered adequate doses of opioids to ensure analgesia. D (diuretics) – Osmotic diuretics such as mannitol and hypertonic saline are used in head injury patients to manage brain edema. The Brain Trauma Foundation guidelines recommend restricting the use of these agents to patients with signs of transtentorial herniation in case in case ICP monitoring is not done. I (intake output monitoring) – Euvolemia should be maintained in these patients. Associated injuries, vomiting episodes, loss of consciousness, and use of diuretics are some of the contributory factors to hypovolemia in these patients. Most ICUs monitor only urine output as output. One must remember the insensible losses that occur through the skin, respiratory tract, stools, etc. N (normocarbia and normothermia) – Fever must be treated promptly as it increases cerebral metabolic rate. Ventilation should be managed to ensure normocarbia. Hypercarbia is deleterious as it increases cerebral blood volume; also hypocarbia is harmful as it leads to cerebral ischemia. J (Jennet and Teasdale devised the Glasgow Coma Scale GCS) – GCS is the most commonly used scale in head injury patients and has 3 components - Eye-opening, verbal response, and motor response. Regular monitoring of GCS is a norm in the ICU. U (ultrasound use) – In addition to the use of ultrasound in airway management, venous access, volume status, and diagnosis of deep vein thrombosis; ultrasound can be used to measure optic nerve sheath diameter which is a noninvasive method of estimation of ICP. R (reaction to light) – The pupillary response to light is routinely measured in ICU in head injury patients. Loss of reaction to light is indicative of raising ICP and is a marker of poor outcome. Y (yankauer suction use) – Whenever performing an endotracheal suctioning, always give a bolus dose of opioids/sedative agents lest a sudden rise in ICP might occur. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Summit Bloria (Mon,) studied this question.