WEEK 2 - post-procedural care

Question 1

What drugs are typically used for:

1. analgesia without a significantly depressed conscious state (rapidly reduces after procedure)

Answer 1

1. nitrous oxide or methoxyflurane and/or an opioid

Question 2

What drugs are typically used for:

2. conscious sedation and analgesia (analgesia + depressed conscious state, still responsive to commands)

Answer 2

2.

• an opioid, midazolam and/or nitrous oxide used ALONE or TOGETHER
• methoxyflurane for children
• low-dose propofol or low-dose ketamine

Question 3

What drugs are typically used for:

3. deep sedation and analgesia (not easily roused, only after repeat painful stimuli)

Answer 3

3. • ketamine or propofol

PLUS IF REQUIRED (one only)

• opioid
• midazolam
• nitrous oxide

Question 4

Requirements for discharge: (8)

Answer 4

• normal/stable vitals
• acceptable/safe cognitive /physical function
• tolerate oral intake (at least fluids)
• avoid driving/operating heavy machinery
• no complex tasks of considerable judgement
• parent/guardian
• no bleeding
• controlled pain/vomiting

Question 5

What is some equipment that would need to be transferred from PACU to the ward? (7)

Answer 5

• IV pump (labelled)
• transfer bed
• oxygen
• paperwork/handover
• emergency bag/equipment
• bed space preparation
• stable patient

Question 6

When is it unsafe to transfer a patient back to the ward? (6)

Answer 6

• full
• cardiac arrest on ward
• unstable vitals, pain, bleeding
• internal bleeding
• decreased consciousness
• unstable vitals - i.e. hypertension, tachycardia

Question 7

Handover in PACU involves checking: (5)

Answer 7

• vitals
• pain level
• dressing
• IV
• med orders

Question 8

What does COLD stand for regarding the transfer of patients across clinical environments?

Answer 8

CONNECT: items to be brought, oxygen, IV
OBSERVATION: alertness, facial paralysis, colour
LISTEN: background, ISABAR, future procedures
DISCUSS: delegation phase, document

Question 9

SLAM for situation awareness stands for:

Answer 9

STOP: think through task, engage brain
LOOK: abnormalities
ASSESS: preparation for unexpected
MANAGE: regroup/discuss

Question 10

What components does a postoperative assessment involve? (6)

Answer 10

1. airway and resp status
2. circulatory status
3. neurologic status
4. fluid and metabolic status
5. level of discomfort/pain
6. wound management