Principles-PACU/Cardioversion/ECT Flashcards
What is the discharge criteria from the PACU to floor
Must be evaluated by Anesthesia
Aldrete Score or modified Aldrete of at least 9/10
Vital signs must be stable for at least 30 min before discharge
NO shivering, but normal temp not required
No opioids for at least 30 minutes
No supplemental 02 for 15 minutes, unless nasal cannula
List discharge criteria from PACU to home
modified aldrete score-outpatient discharge
Discharged to Responsible adult in 1-2 hrs
No discharge if vomiting present
No discharge for residual sensory anesthesia
Ambulate without dizziness or hypotension
May discharge without p.o. intake
May discharge without voiding
What is the Aldrete scoring system
This system is designed to assess the patients transition from phase I recovery to Phase II recovery, from discontinuation of anesthesia until return of protective reflexes and motor function
What does the Aldrete scoring system assess
activity to command breathing Systolic BP LOC Oxygenation
*1-10 scale; > 9 (ok to discharge)
What are the most common problems in the PACU
PAIN, then
N/V
Hypertension requiring tx
Upper airway support needs
Upper airway obstruction is caused by
obstruction of pharynx-tongue falling posteriorly
laryngospasm or edema from intubation
What are the signs of U. airway obstruction
Flaring of nares
Retraction at the sternal notch/intercostal spaces d/t tracheal tug
Unsynchronized abdominal/diaphragmatic contraction
How do you treat a pharyngeal obstruction
Extend head with anterior displacement of mandible (head-tilt-jaw-thrust)
Support respirations
Nasal (awake pts.) or Oral (sedated pts.) airway
How do you treat a laryngospasm
Head-tilt-Chin-lift with + pressure & 100% 02
complete laryngospasm- low dose (10-20 mg) IV succinylcholine followed by DL and intubation
Crycothyrotomy in emergency
How do you treat laryngeal edema
Racemic epinephrine neb tx with 0.25-0.5 cc of 2.25% epi in 5cc water or NS
Dexamethasone
Prolonged upper airway obstruction can lead to
Pulmonary edema
What blood level of Pa02 defines arterial hypoxemia
Pa02 less than 60 mmHg
Pa02 decrease by —– mmHg following upper or thoracic surgeries
20 mmHg
Pa02 decreases by —–mmHg following lower abdominal surgery
10 mmHg
Pa02 decreases by ——following upper extremity surgery
6 mmHg
What are the most common causes of hypoxemia
Increased r-l shunt secondary to atelacstasis
V/Q mismatch which is worsened by decreased FRC and decreased CO
How is hypoxemia treated
Supplemental 02 until problem fixed
*must have sa02> 94% to d/c 02
What causes hypoventilation
decreased CNS stimulation for ventilation r/t anesthetics
respiratory depression r/t prolonged muscle relaxant, or inadequte reversal
Treatment for hypoventilation from inhaled agents
If pt maintaing airway, allow spontaneous recovery
If pt not maintaining airway, cuffed ETT and mechanical ventilation required
Treatment for hypoventilation from Opioids
SMALL doses of Narcan 40 mcg at a time
*rapid administration results in massive SNS discharge leading to pulmonary edema
Treatment of hypoventilation from muscle relaxants
Monitor TOF
May require mechanical ventilation until return of TOF
*Careful not to exceed reversal dose
List the most common causes of hypotension
HYPOVOLEMIA
inadequate blood, or fluid replacement, bleeding
Postop M.I.
and others
Treatment of hypotension includes
Monitoring BP & UO
Trendelenberg position
Pressors and fluid
What cardiac dysrhythmia is most common
Sinus Tachycardia r/t arterial hypoxemia, hypovolemia, or pain
