krnlm

I'm a hospital PACU nurse where we recover patients from a wide variety of sugeries, with all acuities from day surgery to ICU patients. Over my time working there I've learned which CRNAs are best and which are not so good. This week I had an experience which has left me still very shaken. A patient was transferred to me by a CRNA after a 3-hr procedure; report was that he had received Zemuron and 20 mcg of Suffenta with a full reversal. My immediate assessment revealed an unresponsive patient with a blood pressure of 60/30, RR of 4 (but thankfully oral airway still in place), and a quickly decreasing SPO2 (down to 70% in the few seconds before I was able to apply a mask with O2 at 100%). The vitals weren't the worst part, though. The CRNA at the bedside had a very unconcerned manner and kept telling me, "Oh the patient is fine! Don't worry; the narcotics just need to wear off." He did a head tilt/chin lift but nothing else. He did not want to administer any Narcan and only after 5 minutes agreed administer Ephedrine to elevate the continuously low B/P. He also insisted that the breathing was fine because the patient was "taking in plenty of oxygen with each breath" although the RR stayed below 8 for 10 minutes. The patient's O2 was at about 89-90% on 100% O2. After the ephedrine his b/p came up above 110/50 and stayed normal; the RR gradually increased and at 10 min into his PACU time he finally had a RR of about 8 or 9. The patient woke after about 15 minutes and stablized quickly after that. I gave him a liter of fluids and monitored him for 3 hours before transferring him. Thankfully his vitals remained WDL, although I was never able to wean his O2 below 5L. I am still furious. I feel that the CRNA did not want to admit that the patient was overdosing and therefore didn't aggressively treat the situation. I am kicking myself, too, though. I have always treated the CRNA's as a team leader, deferring to them. But in this situation, should I have been more forceful? Should I have pushed him aside and started bagging the patient and administered Narcan? All of my coworkers who were at the bedside said (later) it wasn't my responsibility; the CRNA should have done that. What would you do if you were dealing with this situation?? And what should I do if a similar situation occurs in the future? We called the anesthesiologist but by the time he'd arrived (15 min later) the patient was stablized. So through the entire episode the CRNA was the highest level provider at the beside.

I'm a new PACU nurse; I've only been only the floor for about 2 months. (Although I have several years of MedSurg experience.) I had a quadriplegic patient yesterday who seemed to be going into autonomic dysreflexia after he had a Baclofen pump implanted. He had a high systolic with a sky-high diastolic immediately upon arrival to the unit. Never having seen it myself, I only remembered about autonomic dysreflexia from years ago when I was in nursing school. The CRNA agreed with me that he thought that's what it was, and our anesthesiologist was quick to treat with an order for hydralazine; he also came and assessed the patient himself as soon as he was free. I was grateful that the pressures resolved within a short while. But i was wondering if anyone else has dsalt with this and if there were additional things I should assess for with autonomic dysreflexia other than BP in quadriplegic patients.

Well, I didn't get hired at that position but I did get hired for another PACU job; this one is 10:30-7pm and Monday-Friday. But I don't have to take any night call and the only weekends I have to work is a call every 6 weeks. Hoping it will work out ok and that I can switch to a different shift before too long!! I am excited about the nursing opportunity. It seems like a great job and the pay is fantastic.

I'm an RN who is getting back into the nursing field after taking a 5-year break for raising my kids. I've got a Med-Surg background but don't really want to do those hours or the grind of MedSurg. I've interviewed for a few different Day Surgery positions, primarily PACU. The manager I interviewed with today said she loved me and thought I was highly qualified. (Not counting my chickens before they hatch, though! Lol) It's 10:45-7:15 shift four (occasionally five) weekdays a week with typical Day Surgery call-1 night every other week and 1 weekend every six weekends. Has as anyone worked a shift like this with young children at home? I'm nervous because I will be home just before their bedtime and then not home the nights I take call. Am I crazy for wanting this job so much?? I think I would LOVE it. I've been dying to get into critical care and this looks like a perfect job for my experience level.