ER nurse in the PACU

Perianesthesia Nursing: A critical care approach
Cecil B. Drain

PeriAnesthesia Nursing Core Curriculum -- this book is put out by ASPAN and is a good resource
Edited by Donna M. DeFazio Quinn & Lois Schick

Both textbook type resources, but lots of information

Went to PACU from ER. Some tips

fentanyl 25 mcg g 5 min, max 100, works best for fresh out of surgery pain and does not affect BP (can give it to the lower BP patients). Of course, you have to watch the breathing.

Use Zofran before nausea sets in (as a preventative) and phenergan 6.25mg-25mg (well diluted, very slow push) for nausea and an adjunct to pain control. But, be aware that if pt's bp is low (as compared to baseline/pre-op) then nausea may be do to the drop in BP and all they need is a fluid bolus to resolve the nausea.

Morphine 2-5mg for pain control if pt's BP is high before thinking about giving lopressor or hydralazine. If after 10 mg Morphine you see no decrease in BP, then go the BP med route. Avoid morphine if pt has hx of asthma (histamine release issue)

Before treating for BP issues, check the cuff and repeat. Doesn't hurt to change cuffs to a different size, too.

tactile stimuation to a tubed patient (or freshly extubated one) can facilitiate a laryngospasm. Let em wake up on their own without touching them, avoid suctioning unless necessary. Take the tube out when they can open their mouth/lift their head/squeeze hands, even if they seem to be chewing the tube -need to know that the paralytic has fully worn off.

A fully reversed patient needs a lot of narcotics for pain control.

Here's a good source for a crash course
http://www.nurse.com/ce/CE115-60/CoursePage/

Just to let you know, I think you will do well in the PACU. We have a couple nurses in our PACU who came from ER and have done really well since ER nurses already have the critical thinking/decision making in emergencies. The most important new thing to learn is airway management. I dont know about your PACU but we get patients with ET tubes, LMAs, oral and nasal airways -- so make sure you know extubation criteria and that the patient meets it before you pull the tube! If you aren't 100% ask another more experience nurse for a second opinion. Pain management is also another big part of PACU, especially patients that have are chronic pain med users. But you learn to figure out what works for certain kinds of people (phenergan is a great adjunct to pain meds, but only give a small dose to begin with because it can really snocker some people)

Here is something that helped me in my transition to PACU. Enjoy

Be confident, know the policy and procedure and you will do just fine! Some people are just nasty and closeminded to the fact that a person who doesn't meet their checklist won't fly. Ignore them!

I think as an ER nurse you are used to the fast paced flow of patients and are focused on the immediate issue. In the ER, you don't get bogged down with the patient's xyz medical history, you are treating them for the CC they checked in with. I've seen several ICU nurses who work PRN in PACU get bogged down with things that don't have to do with recovery. That slows down getting the patients moving through PACU. I hate to sound like McDonald's nursing in PACU but awake and alert patients don't need to be held while someone is calling the medical consultant for sliding scale orders. As long as the patient meets discharge criteria, there is no reason to get into all of that. Airway, blood pressure stablization, pain management to a tolerable level, and anti-emetics are your main focus.