OR RN ?? for CRNA's re: low sat tx & waking a pt

subee, MSN, CRNA · Jun 10, 2006

Just looking for some info..
Pt coughing while intubated. CRNA used 30ml syringe with albuterol MDI cannister inside, connected syringe to tubing & depressed cannister a good 10 times. This was at the end of the surgical procedure, before waking patient. Pt had some thin white secretions coming out of tube & nostrils & was suctioned by CRNA. In PACU, CRNA gave report that pt sats had dropped into the 70's & hovered in the 80's during procedure. I was kind of surprised that no mention of this was made DURING procedure. Is this common?
Also, when waking a pt, what techniques are commonly used? Is it common to almost yell "wake up" while slapping pt's face? I can't imagine what purpose slapping someone would serve.
Thanks for your help.

Sounds like the patient was having a bronchospasm. What I don't get is that the whole room would have known that the sats were critical by the the sound of the alarm which strikes fear in everyone in the room. Slapping a patient is abusive and should be reported to the head of the department. There is no reason to yell - in fact, there is every reason to speak softly. We don't anesthetize their hearing! Sounds like this anesthetist needs a reorientation

yoga crna · Jun 10, 2006

I would need a lot more information about the patient, the surgical procedure, the anesthesia technique, etc. to give an educated answer regarding the anesthesia management of this patient.

But, I do know a whole lot about how to wake-up a patient from general anesthesia. I do it very gently, with the OR quiet and warm. I ask the nurses to take the arm restraints off the patients to let them move their arms. (Most of the men reflexly check their genitals to make sure they are still there). There is NO excuse to slap a patient or to yell at them. There are very good ways to stimulate a patient--like a strong jaw thrust and I use it when necessary.

I have found it a very good practice to let the surgeon know if there is an anesthesia problem, so he can be part of the solution. But it is important that you don't make a big deal about little things. Just today, I asked a surgeon to stop a liposuction procedure because of hypotension. I bolused in some fluid, got a good response and he finished the procedure. The next case, I assisted another CRNA while I acted as the circulating nurse (long story), the patient had a clear vagal response to abdominal liposuction. We gave some atropine, some additinal IV fluids and didn't bother the surgeon about it.

The finesse of anesthesia is as important as the science.

yoga

MmacFN · Jun 10, 2006

Yoga said

(Most of the men reflexly check their genitals to make sure they are still there).

I near died laughing. Damn right im checkin if the twig and berries are there! BWahhaha!

rn29306 · Jun 10, 2006

Most of the men reflexly check their genitals to make sure they are still there.

Why you got to bust our chops yoga?

That movement is simply natural. It can be observed in many places, such as the mall, in the hallway in the mornings, and during natural sleep.

Supposedly when doing a US for checking out a baby, if the hands are resting in that area, there is a good chance it's a little man simply hanging on....

athomas91 · Jun 10, 2006

i see they find it early - my six month old is checkin his out.... you men... :)