Patients are often unstable on arrival to PACU and we recover them so they will be appropriate for transfer to the unit, the floor, or discharge. In PACU, anesthesia provides the orders for care. Typically patients do well with a little help and there is no need to involve anyone outside of periop. However, sometimes things don't run smoothly.
Sometimes I've given multiple boluses for refractory room temperature BPs or applied MONA with 12 lead, cxr, and labs for chest pain. In those cases I'll notify the surgical team or main service as a courtesy. Sometimes I must contact them to get an order for a room upgrade or cardiac consult. Other times it is not so clear cut.
If I give a liter bolus of crystalloid with good response by the patient then I typically don't notify the surgeon. Anesthesia and I agree the patient is ready for transfer and I call report and send them to their room. If I give several liters of crystalloid and also albumin then I'll let the service (trauma, burn, medicine, etc) know so they can evaluate the patient and adjust floor orders appropriately.
What is your practice? Also, are there guidelines in your unit for when you notify providers outside of anesthesia?
Mar 9, '17
If a patient is deteriorating, notification is appropriate.
If you are completely comfortable with the situation and need no new orders, it isn't.
When you look back on your life, you won't fret the times you were a little extra careful. You will fret times you were not, and the patient died or had a bad outcome. You can deal with a little heartburn from notifying too early. You can't deal with the heartache from wondering if it was too early, not notifying, then feeling responsible for what comes next.
If you always tell yourself that no matter how uncomfortable the interaction with the physician is, you're there for the patient, you'll like yourself even if you don't like the moment. It's good to like yourself.