Conventional medical school and residency curricula glossed over nutrition for patients and certainly made no mention of how to look after oneself on shift.

Eric and Karine discuss the roles that caffeine, hydration and nutrition play when working in emergency medicine. They look at some good and not-so-great strategies and provide some advice for shift performance enhancement.

Coffee:

Caffeine is the most widely consumed CNS stimulant, and coffee is the world's 3rd most popular beverage. If you drink coffee, you can probably do stupid things faster and with more energy but ... 

Seriously, caffeine has beneficial effects on reaction time, vigilance, and attention, but there is less to suggest that it improves decision making and problem solving.

• Caffeine is an ADENOSINE blocker. It counteracts the CNS depressant activity of adenosine.
• 2 to 3 cups are likely the ceiling of beneficial effect. Restrict caffeine the to the first half of your shift.
• Try a coffee nap:  have a cup or a shot some time prior to your shift, IMMEDIATELY lie down and rest/sleep/doze for 30 minutes. When you wake, the caffeine will be starting to have effect.

Hydration:

• Dehydration of 2% can affect decision making and cognitive performance.
• 1 to 1.5 litres of water over a shift is about right.
• Caffeine does NOT dehydrate you.
• PEE before you put on your PPE (prior to a procedure, critical care etc.)
• Urine colour is a reliable marker of hydration status, so if you are yellow, have a glass!

Nutrition:

• Shift working (especially night shift working) affects circadian rhythms which has detrimental metabolic effects.
• Night workers tend to choose sugary snacks, often out of convenience. Sleep deprivation makes you choose calorie dense carbs and salty snacks. 
• Aim for euglycemia, so avoid high glycemic foods (candy, donuts, fruit juice). Stick to balanced meals with roughage and high protein sources. Snack on fruits, vegetables, yoghurt and nuts.
• Avoid where possible processed foods.
• Eating at end of shift before sleeping? On one hand, you are less likely to wake up ravenous, but some data suggests that the increased body temperature generated after eating can impair sleep.
• Eric and Karine were unable to agree on the concept of comfort food at 0200 hrs being beneficial. You must decide whether a handful of jujubes will prevail over 4 carrot sticks.