Podcast
Questions and Answers
What is the primary goal of a multimodal approach to analgesia in the PACU?
What is the primary goal of a multimodal approach to analgesia in the PACU?
What is a critical component of discharge criteria from the PACU?
What is a critical component of discharge criteria from the PACU?
What is a key strategy for minimizing cardiac risk in the PACU?
What is a key strategy for minimizing cardiac risk in the PACU?
How is hypoxemia typically treated in the PACU?
How is hypoxemia typically treated in the PACU?
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How is respiratory risk assessed in the PACU?
How is respiratory risk assessed in the PACU?
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What is a common component of multimodal analgesia in the PACU?
What is a common component of multimodal analgesia in the PACU?
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What is a key consideration when evaluating discharge criteria from the PACU?
What is a key consideration when evaluating discharge criteria from the PACU?
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How is respiratory compromise assessed in the PACU?
How is respiratory compromise assessed in the PACU?
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What is a common risk associated with hypoxemia in the PACU?
What is a common risk associated with hypoxemia in the PACU?
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What is a key component of cardiac risk management in the PACU?
What is a key component of cardiac risk management in the PACU?
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Study Notes
Phases of Perianesthesia Care
- Continuum of care includes preanesthesia preparation, intraoperative care, postoperative care, Phase I: Postanesthesia/ICU care, and Phase II: Outpatient care
- Purpose of postoperative care is critical assessment and stabilization of patients with prevention and detection of complications
Transport
- Notify PACU of impending patient, extraordinary equipment needed, urgent procedures, and acuity of the patient
- Decide on transport mode: general anesthesia to sedated, spontaneous ventilation requirement, responsive or unconscious patient, and airway reflexes
- Stabilize patient: assure stable condition, administer O2 as needed, monitor ventilation, monitor level of consciousness, and use essential monitors, medications, and resuscitation equipment
PACU Triage
- Admission involves collaboration between CRNA and PACU staff
- Evaluate patient's clinical condition, length/type of procedure, length/type of anesthetic, and potential for complications
- Immediately assess respiratory and cardiac status, note deviations between preop/intraop/postop status
- Anesthesia's role: stabilize, oxygenate, and assess
Initial Assessment
- Determine physiologic status of patient
- Evaluate periodically to identify trends and establish a baseline of medical conditions
- Assess surgical site and prevent/treat complications
Aldrete Scoring System
- Evaluates activity, respiration, circulation, consciousness, and oxygen saturation
- Fit for discharge or transfer = score ≥ 9
Major Body Systems Assessment
- Cardiac, Respiratory, Neuro, Renal, LDAs, and Surgical site
PACU Handoff
- Critical time: exchange of essential information between anesthetist and PACU RN
- Prevent failures of information exchange, which can result in sentinel events and poor patient outcomes
PACU Report
- General Information: name, DOB, surgical procedure, surgeon, and anesthesia providers
- Patient History: acute/chronic conditions, allergies, comorbidities, medications
- Intraoperative Course: anesthetic related, unexpected response, preoperative sedatives, reversal agent, and multimodal analgesics
- Postoperative Plan: concerns, interventions, lab and hemodynamic limits, discharge criteria, and contact person
PACU Complications
- Postoperative Nausea/Vomiting (PONV): incidence, consequences, and risk factors (female, non-smoker, history of PONV, postoperative opioid use, etc.)
- Prophylaxis is key! Identify who is at risk using Apfel simplified risk score
- Evaluate risks and treatments for common perioperative complications
Discharge Criteria
- Includes cardiac, respiratory, and renal assessments, pain management, and other factors
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Description
Quiz covering the different stages of anesthesia care, from preanesthesia preparation to postoperative care, including Phase I and Phase II care.
