seeley

I would say that this patient sounds 'shocky' and is in immediate need of intervention before he ends up perhaps arresting. It was an abdominal case so he likely needs volume and the surgeon needs to be called ASAP! He could just need more volume/ he could be bleeding internally. He needs a stat CBC and lytes drawn too.Doesn't sound like he should have ever left the PACU. Seeley

Dear Mom, I wish you well. My brother was diagnosed many years ago with the 'minimal brain dysfunction' problem (what they called it then). No help for it then really. The doctor tried the then current drug therapy briefly but it caused my brother to have a grand mal seizure within days...phenobarb/Dilantin...I can't remember which...I was only a kid myself...it was the seventies. Anyway, then she did an EEG both while he was awake which was normal, and while he was asleep which showed that he was having seizure activity in his sleep which she said would affect his waking behavior negatively. So, he had a complicated picture...both epilepsy in his sleep and what we now call ADHD. He also tested repeatedly as having a very high IQ which further complicated the whole picture. He was difficult to manage throughout childhood and there were no drugs to help him then...the Dilantin/ phenobarb which she had hoped would sedate his central nervous system thereby slowing him down a tad instead caused him to actually lower his seizure threshold and seize so my family was on their own to cope with him. Long story short the doctor predicted his case correctly...she said he would grow up and outgrow his case of what she called a mild form of 'minimal brain dysfunction' and would eventually mature into adulthood. He did. He is married, and just finished college,double major math and computer science, owns a beautiful house and now has a beautiful child. My nephew has recently been put on Concerta for ADHD and my sister says that it has definitely helped him concentrate. He is in middle school and is very bright but is having a hard time socially as did my brother as a child. My sister has him in a number of sports which he wants to be involved in...it is a hard thing to watch a child struggle socially. My point in replying to you is to let you know know that like all the other postings are telling you, you are not alone...don't hesitate to seek help and don't be afraid of medication if it is recommended...it may help.Children with this problem are a huge challenge to the family system. I hope your child gets the help he needs. Seeley

I have seen music used in the PACU sucessfully with regional anesthesia patients post-op. They can take awhile to show full motor return and sensory block to fully descend. In the meantime, the patient can be relieved of some of his/her anxiety while waiting for this to occur by listening to music with headphones on. One anesthesiologist in particular I have worked with liked using this therapy post-op and intra-op for the patient. It really did seem to alleviate the anxiety of waiting out the recovery for the patient. Problem was keeping track of the headsets...in fastpaced ORs things tend to get lost/misplaced and that was frustrating for this anesthesiologist. It is a nice therapy if you can operationalize it. Seeley:)

We are exeriencing this problem in the PACU where I currently work...we were experiencing that problem in the PACU where I worked before my current employer. It seems to be a problem that is not going to go away. The US population is growing, also living longer and the acuity of care for this aging population is rising...they are sicker than the elderly were even 20 years ago. The demand for health care is rising rapidly. Our hospitals are bursting at the seams. ERs and PACUs have perpetual boarders. Management has fine tuned the capacity of hospitals so that for the most part they are all 100% full (or close to it) most every day here in the state of Maryland. There is no good solution for boaders in the PACU as far as I can see. Patients don't like it and families don't like it...there is no privacy and they are exposed to the ongoing stress of the work of the PACU as the patient is long past PhaseI recovery and into PhaseII...completely aware of his/her surroundings and longs for a private room. The best thing you can do is try to cohort the boarders together in the PACU as far away from the sickest patients that you will be continuing to recover. Pull the curtains so they at least can't see everything going on about them. Let them have visitors and try to remember that it is stressful for them to be there long after they should have been transferred out to a private room.