ECT PACU to PACU in hospital

meandragonbrett · Nov 16, 2012

Recovering ECT patients is going to be very different than working in a PACU in a hospital setting. Things you will see include: etts, nurse driven extubation, ventilators, a-lines, swan-ganz, periph nerve block catheters, continuous bladder irrigations, epidural and intrathecal medications.

Typical drugs you'll see: Phenylephrine, dopamine, nitroglycerine, nipride, Albumin, Hespan, metoprolol, labetalol, hydralazine, morphine, fentanyl, demerol, dilaudid, lasix, albuterol, racemic epi, narcan, neostigmine, robinul, succinylcholine, rocuronium, propofol, remifentanyl, versed, etc.

Inpatient pacu usually involves nurses extubating patients and pulling LMAs (depending on facility), ventilators, frequent hypotension and hypertension that require drips, transfusion of blood products, etc.

Inpatient PACUs are often like short-stay ICUs! :)

brownbook · Nov 17, 2012

meandragonbrett's description of an acute care, major surgery, major trauma, hospital's PACU is very accurate.

However I don't want the description to completely scare you or any other nurse away from PACU.

There are intermediate level of care hospitals that don't schedule or do major surgeries. If these intermediate level hospitals have doctors on duty, emergency rooms, and OR staff, they may receive and stabilize critically ill patients. Then those patients would be transferred to a higher level of care facility.

I don't know what type of care patients require s/p ECT, so I really can't answer your question. If you are thinking of applying just go for it. All they can do is say no thanks.

Topaz7 · Dec 12, 2012

Ok thank you both for responding, sorry it took me so long to reply! I was definitely intimidated with meanddragon's description lol. We typically use labetalol, esmalol, metoprolol, ativan, haldol, benadryl, hydralazine, succinylcholine, etomidate, brevitol, zyprexa, zofran, , emergency meds (atropine, lidocaine, sodium bicarb, and epinephrine) and toradol. As far as post ECT what we might see is LMA's, nasal/oral airways, a-fib or respiratory distress, frequent hypertension which we medicate usually with the labetalol. Medically we don't see a lot of what you described but we do frequently have agitated and combative patients post ECT which we have to medicate.

brownbook · Dec 15, 2012

Your PACU ECT recovery experience sounds more intense than my five years in an acute care (smaller) hospital PACU and my current ambulatory surgery PACU job.

Did you apply? How did it go?

Topaz7 · Dec 15, 2012

Brown - I did not apply. I was curious how different it would be and if it would be difficult or something I might like to transition into once I get my ADN. Sounds less intimidating in a smaller hospital. Maybe that is something I'd be better at or who knows I might just do ok in a larger hospital as well. Guess time will tell :)

PACURN1956 · Apr 1, 2013

I work in a large hospital PACU where we recover everything except NICU patients and Open heart surgeries. We also do elective cardioversions, blood patches and in the past did ECT's but our psych MD's have moved away from those. Although we do see some of everything Meandragon mentioned, it is not on every patient every day and as most PACU nurses will tell you often it is the routine simple surgery that can have the worst outcomes. Three of the 4-5 deaths I have seen in PACU were perm cath insertions. The wonderful thing about PACU is that every patient is something different and while you may work your tukkus off one day, the next may run smooth as clockwork. In my facility the relationship between PACU nurses, anesthesiologists and CRNA's is one of trust and cooperation. It is without a doubt the best place I have worked. I would encourage you to shadow a nurse in PACU and see if it is for you. There is a reason PACU turnover is so low.

Topaz7 · Jul 12, 2013

Thank you for your reply! I might do that! Sorry I have been away for awhile and haven't responded til now.