PACU Final Review - Dr. Reed Flashcards
What is the major cause of PACU issues in our profession? How does it manifest, and how would you treat it?
Airway compromise. Usually due to inadequate reversal of NMB
Snoring, Accessory muscle use, somnolence
Give more reversal, Stimulate patient, jaw thrust/chin lift, nasal or oral airway, CPAP (10-15cmH2O), reintubation
Clinical Scenario. You believe your patient in PACU is having a bronchospasm. What makes you think this? What could be the cause? How do you treat?
S/S: wheezing, dyspnea, use of accessory muscles, tachypnea, high PIP if intubated.
Possible Causes:
-aspiration
-suctioning
-endotracheal intubation
-histamine release from medications
-allergic reaction
Tx:
Confirmation and removal of cause
Medication admin to reduce airway irritability/resistance and bronchodilator
-SABAs such as albuterol
-LABAs such salmeterol
-Epi if life threatening
Anticholinergics such as atropine, glycopyrrolate, and ipratropium
Clinical Scenario. You believe your patient in PACU has aspirated. How do you treat?
Treatment should be applied to correct hypoxemia and hemodynamic stability if gastric aspiration is suspected.
No prophylactic abx
The patient’s oxygen saturation has fallen; what are some interventions you can do?
Obstruction: Ensure patient airway - jaw thrust, Oral Airway, CPAP
Increase FiO2, Positive pressure ventilation, and reversal agents.
Atelectasis: humidified O2, cough, deep breath, sit up, incentive spirometry, positive pressure ventilation
What is the best FIRST course of action when you suspect the patient is having a laryngospasm?
Jaw thrust maneuver in conjunction with CPAP (up to 40cmH2O), sub paralytic dose of succinylcholine (0.1-1 mg/kg IV or 4 mg/kg IM)
What is the best FIRST course of action when you suspect the patient is obstructing?
Initial intervention may need to stimulate the patient to take a deep breath.
Next would be a jaw thrust or chin lift to maneuver airway.
Oral airway or CPAP (10-15cm H2O)
Components of the Aldrete Score
combo of scoring systems and body systems
○ 5 categories scored for 0-2 points each
- Activity (moving head, extremities, voluntarily, on command)
- Respiration (apneic, labored/limited, normal)
- Circulation (high or low BP, stable)
- Neurologic status (not responding to painful
stimuli, to verbal stimuli, normal) - O2 saturation (< 90 with O2, > 90 with O2, >
90 without O2
> 9 often threshold for discharge out of PACU (not requirement for ASPAN, but many facilities use it)
What are some endocrine responses to unrelieved pain?
Increased:
ACTH, Cortisol, AntiDiuretic Hormone, Epinephrine, Norepi, Growth hormone, Renin, Angiotensin II, Aldosterone, Glucagon(increases blood glucose), Interleukin-1(excess inflammation)
Decreased:
Insulin and Testosterone
What are some metabolic responses to unrelieved pain?
-Gluconeogenesis - glucose production in the liver and kidneys
-Hepatic Glycogenolysis - break down of glycogen to release glucose
-Hyperglycemia
-Glucose Intolerance
-Insulin Resistance
-Muscle Protein Catabolism - important process, but too much can lead to skeletal muscle wasting
-Increased Lipolysis
What are some cardiovascular responses to unrelieved pain?
Increased:
Heart rate, cardiac workload, PVR and SVR, Hypertension, Coronary Vascular Resistance, Myocardial Oxygen Consumption, Hypercoagulation, DVT
What are some respiratory responses to unrelieved pain?
Decreased: Flows and Volumes, Cough
Atelectasis
Shunting
Hypoxemia
Sputum Retention
Infection
What are some genitourinary responses to unrelieved pain?
Decreased urinary output
urinary retention
fluid overload
hypokalemia
What are some gastrointestinal responses to unrelieved pain?
Decreased gastric and bowel motility
What are some musculoskeletal responses to unrelieved pain?
muscle spasm
impaired muscle function
fatigue
immobility
What are some cognitive responses to unrelieved pain?
reduction in cognitive function
mental confusion
