Jeepluv77 Posted June 27, 2009 Share Posted June 27, 2009 On Wednesday(June 24) I had my PACU rotation. That was the most pointless, boring 8 hours of my life. Even my "unstable" patient presented nothing of any value to my training. She had an aspiration pnuemonia(I've got a son with asthma. Been there done that.) Am I the only one that has had this experience with PACU? Was there a point to this shift that I'm missing here? The only good part was that I had the idea to put her on humidified o2 and she stopped dropping her sats. Link to comment Share on other sites More sharing options...
chbare Posted June 27, 2009 Share Posted June 27, 2009 On Wednesday(June 24) I had my PACU rotation. That was the most pointless, boring 8 hours of my life. Even my "unstable" patient presented nothing of any value to my training. She had an aspiration pnuemonia(I've got a son with asthma. Been there done that.) Am I the only one that has had this experience with PACU? Was there a point to this shift that I'm missing here? The only good part was that I had the idea to put her on humidified o2 and she stopped dropping her sats. Then, either your preceptor cheated you out of a good experience, or you did not try to make it a good experience. PACU is a great place to hone your assessment techniques. Assessing neurological function and dermatones following spinal anesthesia is a great exercise. Monitoring post surgical mental status, airway issues, and hemodynamics is also a great exercise. This is also a great time to learn about pharmacology and physiology. You can talk about the different anesthesia techniques, learn about inhaled gasses. Do you know what a minimum alveolar concentration of an inhaled anesthetic is and how this relates to your patient? In addition, this is the perfect time to review the pathophysiology and management of malignant hyperthermia. The PACU staff should be well versed in managing this condition and you can learn how the treatment works (Dantrolene). PACU is a great opportunity to learn. Take care, chbare. Link to comment Share on other sites More sharing options...
paramedicmike Posted June 27, 2009 Share Posted June 27, 2009 I've gotta agree with chbare. When presented with clinical rotations like this you need to go after him/her and figure out on your own what you can learn. Ask as many questions as you can think of and then ask some more. Even if there aren't many patients, or sick patients, in the unit there are still a wide variety of learning points available to you. Ask to go back. -be safe Link to comment Share on other sites More sharing options...
Jeepluv77 Posted June 27, 2009 Author Share Posted June 27, 2009 I will ask to go back. To a different hospital though. I think it was just the nurse. She was really nice, but she seemed to get overwhelmed easily. She was managing two patients and kept telling me she didn't have time to explain this or that even though both pts were pretty stable. Before we got the patients in she did go over the spirometry and how it helps to reopen the alveoli but that was about it. I asked as many questions as I could, but didn't get many satisfactory answers. For example, she never did really explain why our pt with aspiration pneumonia did worse after racemic epi(it was given before we knew she had aspirated). I noticed the sputum was pink tinged and asked if it was possible the pt had undiagnosed chf and the only answer I got was no. Never did get an answer as to why it was pink or to how they could definitively say it was not chf without further testing. The pt was 73 incidentally. I also saw her give some meds that I thought were unwarranted given the situation, like diphenhydramine, decadron, and the racemic epi. Especially the racemic epi, because I was taught it was for upper airway swelling and it was clear on auscultation that the wheezing was from the lower airway. Link to comment Share on other sites More sharing options...
VentMedic Posted June 27, 2009 Share Posted June 27, 2009 I gotta agree here also with the others. PACU is a great place to learn assessment, pharmacology and some pathophysiology. Either your school did not adequately prepare you with enough knowledge or you may not have enough interest in medicine to take the initiative to get involved. BTW, I see a lot of mothers and fathers of children with asthma and unfortunately many know very little about it. Also, to compare asthma to aspiration PNA is not even in the same ball park as far as the medical issues involved. Link to comment Share on other sites More sharing options...
Jeepluv77 Posted June 30, 2009 Author Share Posted June 30, 2009 For the record, I wasn't comparing the two. He developes aspiration pneumonia occasionally with his asthma. The doctor says it's probably because he's working so hard to breath that he's probably not clearing his throat adequately. We aren't talking has an asthma attack, gets a hit of albuterol, is all better. We are talking gets a cold and his airways nearly shut down. Then he starts Albuterol, Atrovent, Orapred, Pulmicort, and they usually have me give him benedryl and delsym and an antibiotic for the PNA, too and he still ends up in the hospital every few months. I really think they've missed something and that he needs to see a pulmonologist, but they insist it's not necessary. I don't think a 2 year old should be a walking pharmacy(at least not without a full work up) but they seem to think that's normal. I'm looking into finding another pediatrician. He's been allergy tested and they found nothing but that's about it. As to the shift problems, believe me, it's not a lack of interest in medicine. I've dreamt of working in medicine since I was a kid, just took me awhile to figure out where. I talked to another student and she had the same problem with that nurse. We've reported it to the school so they, hopefully, will not schedule any more students with her. Great nurse, terrible precepter. Link to comment Share on other sites More sharing options...
cosgrojo Posted June 30, 2009 Share Posted June 30, 2009 Do you know what a minimum alveolar concentration of an inhaled anesthetic is and how this relates to your patient? http://www.anesthesia-analgesia.org/cgi/co...t/full/97/3/718 chbare- you are one frighteningly in-the-know individual... after reading this very long article of technical medical charts and 80 years of speculation and theories and science, I had to scrape my brain off of the keyboard, and untangle the knot that it was twisted in... but on the bright side, I just spontaneously figured out how to solve a Rubik's cube. Thank you for ruining the last 25 minutes of my life. Link to comment Share on other sites More sharing options...
Richard B the EMT Posted July 1, 2009 Share Posted July 1, 2009 Once again, expect the sound of me slapping my palm to my forehead when you tell me, but...what is/are PACU? This may be, yet again, using a wording I am unfamiliar with, that describes something I AM familiar with. Link to comment Share on other sites More sharing options...
cosgrojo Posted July 1, 2009 Share Posted July 1, 2009 PACU - Post Anesthesia Care Unit Link to comment Share on other sites More sharing options...
VentMedic Posted July 1, 2009 Share Posted July 1, 2009 For the record, I wasn't comparing the two. He developes aspiration pneumonia occasionally with his asthma. The doctor says it's probably because he's working so hard to breath that he's probably not clearing his throat adequately. We aren't talking has an asthma attack, gets a hit of albuterol, is all better. We are talking gets a cold and his airways nearly shut down. Then he starts Albuterol, Atrovent, Orapred, Pulmicort, and they usually have me give him benedryl and delsym and an antibiotic for the PNA, too and he still ends up in the hospital every few months. I really think they've missed something and that he needs to see a pulmonologist, but they insist it's not necessary. I don't think a 2 year old should be a walking pharmacy(at least not without a full work up) but they seem to think that's normal. I'm looking into finding another pediatrician. He's been allergy tested and they found nothing but that's about it. As to the shift problems, believe me, it's not a lack of interest in medicine. I've dreamt of working in medicine since I was a kid, just took me awhile to figure out where. I talked to another student and she had the same problem with that nurse. We've reported it to the school so they, hopefully, will not schedule any more students with her. Great nurse, terrible precepter. I have a feeling you are going to drift from EMS and go into another profession or moonlight at something else. Have you read the new Asthma Guidelines; EPR 3? http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm PACU sometimes is like EMS if you look at the standing orders. That could also explain the Racemic Epi. PACU can be like an assembly line and sometimes things get done just because. It drives me nuts when I see the patient (or finally get called to PACU for an assessment) to hear "we tried all this (pointing to a recipe of standing orders) and still have that". I went into RT because I sometimes felt helpless with the protocols I had as a Paramedic and I found out I had unrealistic expectations. That one Albuterol neb was not always going to miraculously take away the wheezes and just putting an ETT into someone did not always make the respiratory distress or air hunger better. There may be another role, in addition to EMS or instead of, for you especially since you have seen what it is like for someone close to you to experience true respiratory distress. Until then, if you can not find anything interesting around you, read the standing orders and protocols books of the units/EDs you will visit. You will find out how they manage sedation, sepsis, BP issues etc. BTW, I am a big fan of Pulmonologists and especially those that specialize in kids. Link to comment Share on other sites More sharing options...
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