Neurological, temperature and discharge - PACU

Question 1

Delayed awakening causes

Answer 1

• Drug effects
• Metabolic disorders
• Neurological disorders

Question 2

Emergency delirium - risk factors

Answer 2

• pre-existing dementia or confusion
• Advancing age (>65)
• Alcohol use
• Hearing or vision impairment
• Prescence of urinary catheter or ETT
• Surgical blood loss with post-op Hct <30%
• Intraoperative complications, e.g., hypoxia
• Use of psychoactive drugs, i.e., Ketamine
• Hypoglycaemia
• Pain

Question 3

two components of heat input

Answer 3

1. internal heat production
2. heat transfer from the environment
   *disruption to these two principles will produce either hypothermia or hyperthermia.

Question 4

Hypothermia - causes

Answer 4

Temp drops below 35.
- intrinsic factors
- surgical factors
- environmental factors
- general anaesthesia

Question 5

Hyperthermia causes in PACU

Answer 5

• bacterial or viral infection
• over-heating with artificial warmers
  Some meds - psychotropic drugs, SSRI’s, MAOI’s and tricyclic antidepressants
• Malignant hyperthermia

Question 6

Malignant hyperthermia

Answer 6

type of severe reaction that occurs in response to particular medications used during general anesthesia,

Question 7

Malignant hyperthermia signs

Answer 7

tachycardia, tachypnea, hypoxemia, hypercarbia, metabolic and respiratory acidosis, hyperkalemia, cardiac dysrhythmias, hypotension, skeletal muscle rigidity, and hyperthermia.

Question 8

Discharge from PACU

Answer 8

• Minimum observation time of 30 minutes
• Pt can adequately maintain their own airway
• Pt is hemodynamically stable
• 02 sats not <93%
• Sedation score not > 2
• Vital signs within 20% of baseline
• Pain scores not >3
• Normothermic