New job in PACU

[sunflowergrl70]

I've been a nurse in the OR for almost 7 years in a busy trauma hospital. Before that I worked on a accute care med/surg floor. I managed to get a job in the PACU of a smaller hospital. I'm psyched and scared all at once. I have been ACLS certified for years. Any suggestions for a newbie?

[GHGoonette, BSN, RN]

If you've worked in OR, you already know much of what you need. You've probably assisted anaesthetists and /or CRNAs and you understand the dynamics of anaesthesia and its reversal. There's really nothing to be scared of :)

If you want the basics of PACU, read through some of the threads, you'll get a lot of info from them. Then there's also this one from the OR forum:

https://allnurses.com/operating-room-nursing/scrub-nurse-recovery-509419.html

As a matter of interest, when you say "small hospital", what do you mean? How big is their ER and what kind of cases do you expect to see in theater?

[meandragonbrett]

There's not much to actually WORKING in PACU other than your ABC's and surgical sites but you DO need to have a good knowledge base for when things don't go quite as planned. Know how to manage an airway including ambuing, oral and nasal airways, endotracheal tube management, and Laryngeal Mask Airway management. Read up on your narcotics (Fentanyl, Dilaudid, Morphine, Sufenta, and Remifentanyl), anti-emetics (Zofran, Phenergan, and Inapsine.). Be familiar with versed, ephedrine, phenylephrine, albumibn, hespan, propofol, sevoflurane, desflureane, isoflurane, neostigmine, and robinul.

Those are the most common medications you'll encounter in the PACU. If you have a high acuity PACU that admits ICU patients also you should be familiar with levophed, epi, cardene, nipride, chest tubes, trachs, etc.

Be familiar with reversal agents such as Narcan, Romazicon, and protamine. One thing to note....in PACU we general don't give entire "rescue" doses of reversal such as 0.4mg of Narcan. We generally dilute it down and titrate to effect (i.e. the patient is now spontaneously breathing again). I gave .05mg of Narcan about two days ago. I can honestly say I have never given a 0.4mg dose in PACU.

Just a few things to consider!

Good luck.

[ILBCNU]

I am an RN with 15 yrs med/surg experience and recently got my ACLS due to the fact our floor is adding telemetry. I have a friend from nursing school who works outpatient PACU at a large area hospital and has talked to her boss and she is considering hiring me PRN and train me. I always thought ICU or OR or GI experience was required, which is probably what her boss would prefer. I have been at this other hospital for years and have always worked nights, which is getting old. I am afraid that I may not cut it as far as having such little experience in this area. I want a change, but would feel terrible if I get hired and they decide that they should have hired someone with more experience. At least you have worked OR. I would think that would be the best experience to have. Good luck!

[GHGoonette, BSN, RN]

For an outpatient PACU, you'll only have to deal with less invasive procedures anyway. I doubt whether you'll have any intubated patients, possibly LMAs, but most of your patients will likely be either sedation, local anaesthetic or light anaesthetic. Just get to know the action and side effects of your volatile liquids, eg sevoflurane, induction agents such as propofol, opioids like fentanyl and benzodiazepines like romazicon. It's unlikely they'd use muscle relaxants in an out-patient theater, and in my experience those are what usually cause hairy moments!

Don't worry, you'll be fine!