PACU rotation

[Timmy]

So many different names lol…

We call it post operative recovery in Australia.

I love working post op, its quiet a busy and challenging environment.

We complete a full set of vitals signs every 15 minutes for the first hour and half hourly for the next four. (I’m surprised they didn’t stick the student with this job lol) The patient has to expel the tube, airway management and suction, attending to wound care, pain management, managing infusions, IVs and medications, drains and vac drains, fluid balance documentation, post op documentation (a lot of), monitor for signs of hypoverlimia, post op general and breathing exercises. limb observations, implementing care plans and treatment pathways, organizing the return to ward, managing nausea and anxiety, liaising with the doctors family and allied health guys n gals nutrition and fluid intake. The list of things to do is endless, if something goes a little pear shaped with one the patients it throws you right out with everything else you had to do.

I like to research new procedures or medications before I go to do them, as already mentioned a lot of people get caught up with just doing it because its always been done that way. I find things flow a lot smoother if you know what you are doing and why you are doing it. I find an 8 hours shift fly’s by even if you have 4 patients under your care.

I know all this really doesn’t appeal to paramedic students but placement is what you make it.

Edited July 1, 2009 by Timmy

[chbare]

So many different names lol…

We call it post operative recovery in Australia.

I love working post op, its quiet a busy and challenging environment.

We complete a full set of vitals signs every 15 minutes for the first hour and half hourly for the next four. (I’m surprised they didn’t stick the student with this job lol) The patient has to expel the tube, airway management and suction, attending to wound care, pain management, managing infusions, IVs and medications, drains and vac drains, fluid balance documentation, post op documentation (a lot of), monitor for signs of hypoverlimia, post op general and breathing exercises. limb observations, implementing care plans and treatment pathways, organizing the return to ward, managing nausea and anxiety, liaising with the doctors family and allied health guys n gals nutrition and fluid intake. The list of things to do is endless, if something goes a little pear shaped with one the patients it throws you right out with everything else you had to do.

I like to research new procedures or medications before I go to do them, as already mentioned a lot of people get caught up with just doing it because its always been done that way. I find things flow a lot smoother if you know what you are doing and why you are doing it. I find an 8 hours shift fly’s by even if you have 4 patients under your care.

I know all this really doesn’t appeal to paramedic students but placement is what you make it.

No worries, it was called "recovery room" when I was a nursing student. I found the experience similar to your experience.

Take care,

chbare.

[Jeepluv77]

VentMedic, as usual, you're right. I plan on working as a full time medic till it starts to really take a toll on my body. At that point, I'll choose my specialty and cut back to running rescue once a week. The asthma isn't the only major medical issue I've dealt with in my family. My alcoholic father survived bilateral subdural hematomas(twice), my oldest son had repeated bouts of status epilepticus(he's "outgrown" it and we never found a cause), my second son was born at 33 weeks after placenta abrutio, and my third son(with "asthma") was born at 32 after PROM at 22 weeks(I spent 9 of the 11 weeks in t-burg). Hence the difficulty choosing a specialty. I'm leaning towards the PICU because the number of parents that never even bothered to show up for their kids was heartbreaking. I figure maybe I can comfort them and more importantly help mom and/or dad get more involved. Some just don't seem to understand their importance in their child's recovery. One even told me she just couldn't take it and wasn't coming back till he was discharged. When you become a parent, you lose the right to run and find a way to "take it".

Thank you sooo much for the link. I'm trying to learn anything I can. I worry about the long term effects of so much medicine being pumped into such a young child. Or anyone for that matter. Not to mention that even though it's easy for me to manage his meds it's very confusing for dad and I worry about it while I'm at school or on shift and he's in a flare up. I always right down exactly what medication and what dose he gets at the exact time, but I still worry I'll get that call that he was overdosed or underdosed. Also, the doctor doesn't want me to use the Atrovent(it was prescribed by the ER doc, but without it we make multiple trips to the ER to have him stabilized and sent home. Seems stupid to me that I can give it to my patients but not my son. We finally compromised and I can give him one dose every 4 hours, but if he needs more than that in we go. They are also starting him on Singular and Zyrtec after his ear tubes are placed. Which is a whole other dimension of this because he never had infections till about 6 months ago.

As to the actual shift, I have decided if I get surgery it won't be there. Not once did any of the nurses manually check vitals. In eight hours, twelve patients, not one set of vitals taken manually. They just glanced up at the monitor. And that was only on occasion. I took most of mine manually not only for the practice(we do them all manually on our trucks) but also to check for discrepencies. The bp was normally accurate, but the pulses were all over the place. They should have at least gotten their baselines manually, IMHO.

[VentMedic]

They just glanced up at the monitor. And that was only on occasion. I took most of mine manually not only for the practice(we do them all manually on our trucks) but also to check for discrepencies. The bp was normally accurate, but the pulses were all over the place. They should have at least gotten their baselines manually,

This is not uncommon especially if the patient has had a full workup prior to surgery and has been continuously monitored throughout the surgery. The baseline has been established. However, I would hope they are checking some pulses manually if nothing else to check perfusion. We do check manually if the patient and assessment don't look like the numbers on the NIBP screen or A-line.

[Jeepluv77]

I was a little concerned about our respiratory pt because her readings were shifting all over the place. For example, she was at 130/60, 158/60 7 mins later, 163/63 5 mins later, 138/46 10 mins later. At this point her pulse pressure stayed very wide and she had started having frequent PVCs. At one point she had 11 in less than a minute even though her heart rate was 74. The nurses seemed very unconcerned about this and when I asked about why it was happening her answer was "I'm not sure". That was it. Even when the doctor came in to consult on the pnuemonia he seemed unconcerned. Is this normal post-op? Could it have just been the meds?

BTW, thanks for helping me understand all this. I kept careful notes and have been researching to try to better follow it all. You've been a huge help!

Edited July 1, 2009 by Jeepluv77

[Richard B the EMT]

PACU - Post Anesthesia Care Unit

OK, that sounds like an ALS related protocol. I, as has been discussed in numerous postings, am BLS, so, you now hear the sound of silence, not the sound of the palm to forehead slap. Thanks for the information.

[chbare]

OK, that sounds like an ALS related protocol. I, as has been discussed in numerous postings, am BLS, so, you now hear the sound of silence, not the sound of the palm to forehead slap. Thanks for the information.

PACU is not a protocol, it is an area of the hospital where patients are monitored following general anesthesia. You may be familiar with the term "recovery room." A recovery room and a PACU are typically one and the same.

Take care,

chbare.

[cosgrojo]

OK, that sounds like an ALS related protocol. I, as has been discussed in numerous postings, am BLS, so, you now hear the sound of silence, not the sound of the palm to forehead slap. Thanks for the information.

Despite being a BLS provider myself, I was aware of what the PACU was... partly because I've woken up there once, and having done my fair share of transfer work at hospitals, am familiar with those departments. I've also done 911 calls there. In fact just last night we went to an out-patient day surgery clinic to pick up a patient having complications s/p endoscopy procedure and brought them to the ER at the local hospital.

[Richard B the EMT]

OK, this starts being a local terminology situation. I say "Recovery Room", some others say "post operative recovery area", yet others say "Post Anesthesia Care Unit-PACU".

Can we agree that You say Poh-TAY-toh, and I say Po-TAH-toh? Turns out to be the same thing.

As for the BLS/ALS issues, are ALS personnel allowed, under supervision of Anesthesia Specialists, of course, to perform intubation as a part of their training?

I seem to recall hearing that the People for the Ethical Treatment of Animals objected to student Paramedics learning pediatric intubation by practicing on cats at veterinary hospitals, again, under strict and tight supervision by authorized specialists.

[VentMedic]

Can we agree that You say Poh-TAY-toh, and I say Po-TAH-toh? Turns out to be the same thing.

As for the BLS/ALS issues, are ALS personnel allowed, under supervision of Anesthesia Specialists, of course, to perform intubation as a part of their training?

I seem to recall hearing that the People for the Ethical Treatment of Animals objected to student Paramedics learning pediatric intubation by practicing on cats at veterinary hospitals, again, under strict and tight supervision by authorized specialists.

I felt much better when we used ferrets aka weasels. But still an animal.

I really felt bad when we used long floppy earred bunny rabbits for chest tube insertion training.

This was for Neo/Pedi ICU/transport.

But then in my early days as an RRT, in the research labs we used to drown dogs by pouring either fresh or salt water down their tubes to study the differences.

Edited July 2, 2009 by VentMedic