Specific Questions about the PACU

1) It all depends on the hospital's policy, anesthesiology, ICU staff, PACU staff, and patient status. At my particular hospital, the PACU nurses prefer that the patient go straight to ICU if the plan is to keep the patient on the ventilator. However, some anesthesia MDs refuse and want the patient brought to us first. It's kind of a pat on the back that they think highly of us, however it is PITA for several reasons. The vent has to be set up in PACU, then moved to ICU, it ties up 2 PACU RNs getting the patient settled only to turn around and move the pt again in maybe an hour. Open heart patients are the exception, they go straight out to their own CVICU.

2) Breath sounds! Also vascular checks, heart tones, neruo checks.

3) Art lines are the most common, carotid endarectomies always have them. Art lines are also put in if it's a long spinal case where the patient is prone, patients with severe cardiac disease, patients who are shocky/hypotensive. CVP monitoring is typically done with any large abdominal case in a patient who has several co-morbidities. PA lines are few and far between (expect open hearts, they will have it all) and I usually just see the PA cath on open AAA repairs.

4) Get comfortable with the basic drains--JP, hemovac, penrose, chest tubes. Have someone show you how to properly empty them, and always check the surgeon orders for if the drain should be compressed or placed on suction. Chest tubes just look intimidating---just make sure the patient is not lying on the tubing and generally they are on -20cm suction and not clampled. Make sure you know what an air leak is on a chest tube.

5) You will probably learn quickly what to do when a patient is obstructing---holding the airway, placing an oral/nasal if the pt does not come out with one, and sometimes you'll see a patient with an LMA or ETT. Know the protocol for removing these tubes, have suction ready. You will probably see nebulizer treatments given fairly often. As far as common IV meds, there have been several other topics addressing this area.

Enjoy your experience!