Need for “Nutrition” has been hotly debated and somewhat blindly held up as a critical need according to the mnemonic “HITMAN.” This should not be the case! Though important in some less injured patients, feeding a patient, especially one who requires feeding by NG tube, can be fraught with problems. Justin interviews Dr. Chris Burns on the potential perils and pitfalls of blindly following the “N” in HITMAN
Check out the show notes below:
As we charge ahead in managing sick patients in austere environments, we look for memory aids and develop mnemonics to make a daunting job easier. Enter one of the original mnemonics used in the community: HITMAN. This, like many tools, has become gospel for some providers. Time to rethink the dogma.
We, in the medical community, don’t understand all the nuances associated with critical care, and discussions on “nutrition” are somewhat unfamiliar. As such, we may encounter pitfalls commonly seen in hospitals. In fact, in ICU patients, teams of doctors consult nutrition experts to render opinions on the technicalities of feeding patients, and many patients go many DAYS without nutrition.
Who can you feed? Anyone awake and alert enough to say they’re hungry (and understand what they’re saying). All others, cool your heels and resist the urge to shove Muscle Milk down an NG tube!
I really like Greg Barefoot’s comments about physiology and metabolism so I’ll include it in full here,
“Just listened to the podcast that Justin and Dr. Burns put out. Great stuff. We do the same thing in my shop on the trauma service. I would also like to add that the 125cc/hr rate comes from the protein sparing effect of D5 IVF has on the body whereby providing 3 liters of D5 you have supplemented 150 grams of dextrose to supply the body with substrate over 24 hours. In regards to the NG tube feeds, I like to think about the body’s physiology from the “caveman” point of view. If he were to be attacked by the saber tooth and survive the insult, he will hunker down in his cave and let his body do the rest. His body will utilize its own stores for a period of time due to evolutionary adaptations. Additionally, return of gut function in terms of days is usually- Small bowel 0-1 day, Stomach 1-2 days, Large intestines 2-3 or more days. Some have suggested 0,3-5,5-7 days as the numbers if they have had surgery on the bowel…Just some thoughts. Keep up the great work.”