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New to PACU; question about how "bad situations" are dealt with typically.

Specializes in Med/Surg.

I was a med/surg nurse on a 60 bed unit for 3 years, then in a cardiology office for 2 years. Now I am in what I would call a "very small" hospital (they have about 40 beds, and about 10 of those are "ICU" beds, which is very rarely full, and often the ICU patients are not what I would call a typical ICU patient). I am very new to PACU, and I acknowledge that (I started working 2.5 months ago in PACU). This is my first job that you could classify as "critical care" so I know I lack experience in this. A few days ago one of the PACU nurses had a situation that makes me uncomfortable and I was wondering how this situation would be dealt with typically. We do a lot of outpatient surgeries in our PACU, and most really are outpatient, although the total knees/hips go to the floor. One of the cardioversion patients HR went down in to the 10's after cardioversion, and then stayed in the 30's. The other nurses said the patient was still awake, etc but she was definitely ill-looking and drowsy (I saw her). **After the cardioversions here, the cardiologist leaves immediately, so he was not there for the heart rate issues. He was notified via phone but stated "lets just keep an eye on her and admit her to ICU". I am probably being paranoid because I am not accustomed to these types of issues, but I keep thinking what if she had gotten worse and in the meantime an RRT had not been called? Would the nurse be at fault for knowing the policy states that an RRT should be called for a heart rate that low, and one wasn't called? I am thinking worse case scenario/if she would have deteriorated and we could have prevented it by calling an RRT (and probably over-thinking, or at least it feels like it). This patient was in the PACU with a low heart rate in 30's for about 20-30 minutes. I guess a rapid could have been called if her mental status declined further etc, or HR got worse.

Rose_Queen, BSN, MSN, RN

Specializes in OR, education.

There are some units where rapid responses are not called, because everyone who needs to respond works there. Our ER handles their own codes and RRs; the facility team does not respond. The same is true of our OR and PACU- we have the ACLS certified nurses and airway support (anesthesia). If the patient condition deteriorated, then you should follow the protocols for your area- for me, that means we overhead page just in the department for a response.

LinLanCPAN

Specializes in Critical Care, PACU.

In each PACU I've worked in, situations like that were handled "silently," meaning that there was no overhead page, etc. Since we are all supposed to be ACLS certified, and our anesthesiologists are readily available to us, it's normal for us to monitor and manage those situations without outside assistance. We would, of course, notify the cardiologist involved immediately, but it sounds like that was done and he was aware and ok with her management. We pretty much are our own RRT in PACU.

Well......it was a real scary situation, and of course IF the patient's condition had deteriorated to the point of a code then all the medical/nursing care would be reviewed.

I can't say the nurse would be at fault though. Depending on the work culture where you work it could be (should be) handled as a non judgmental, what happened, how could you (we, your co-workers, the cardiologists, etc.) have handled it different. Lets have an in service on when to call RRT or have a code blue practice/drill, etc.

My patient had a similar situation after a routine surgery. His heart rate and BP were low for almost an hour. It scared me to death, though I tried to stay calm, (I'm sure my heart rate and BP were sky high)! I notified the anesthesiologists, the patient had history this type of reaction, I just continued to observe him. However afterwards I got a tiny cheat sheet taped to my name tag on ACLS protocol for bradycardia. (I have taken ACLS a billion times, still my brain goes blank in a code!)

We (both the main OR and PACU) handle our own codes. Anesthesia is paged to the bedside internally and one is always available immediately to handle critical situations, along with all our ACLS/PALS certified RNs.

I am a PACU Nurse as well and we also don't do overhead pages because essentially everyone you need is already there. All of our PACU Nurses are ACLS and PALS certified and if something occurs we typically handle it and update Surgeon as we go. Welcome to PACU Nursing, I absolutely Love it!!!

Txg159

Specializes in Pacu.

I am a pacu nurse as well and like those commenting before me we handle our own "codes" silently. The anesthesia staff is our resource and it is anesthesia that we take our post op orders from. Pacu is a different world if nursing but I love it!! Welcome and good luck!

azhiker96, BSN, RN

Specializes in PACU.

Anesthesia providers call the shots in PACU and they are quite skilled at intubation if needed. I've had a couple of patients have MIs in the PACU but we controlled it quickly and then transferred to ICU with a cardiac referral once they were stable. There is always lots of help.

I agree txg159- the fact that the PACU is so different than the rest of the hospital/the floors is one of the things I love about it. When I worked on the floor I could not say that I felt 100% confident that all the nurses on the floor could handle an emergency situation as best as possible. I can say that about our PACU because I've SEEN almost everyone handle and emergency and all my fellow nurses in the PACU are so competent. Heck, even our techs who do our stocking/transprting are great at anticipating what to get and bring to the bedside during an emergency, or who to call or what to cover. I love bragging about my PACU...when I'm not at work wanting get the heck out!

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