General Anesthesia Part 2, Emergence and Recovery

[@cassandrawall541]

Thank you so much for these videos! I'm an ER nurse starting a job in a PACU and these have been so helpful to me.

[@pacunursingminutes]

Cassandra, thank you for the kind words! Your the reason I get up and teach every day!

[@pacunursingminutes]

Your absolutely welcome, glad to share with my fellow tribe of nurses! Stay tuned for more PACU content!

[@jenniferjackson4379]

Thank you so much bc there are no pacu specific information which I have been searching for a long time

[@pacunursingminutes]

Hi Jennifer Thank you for your comment! I’m glad you enjoying the videos!

[@jenniferjackson4379]

@@pacunursingminutes I would like to be better with caring for dementia patients after anesthesia, patients with addictions to recreational drugs, and mental health illnesses. I have had schizophrenic patients screaming after anesthesia but was limited bc she was also a renal patient. I have had a bipolar patient with no medication regimen and didn’t well with anesthesia.

[@jenniferjackson4379]

@@pacunursingminutes also a malignant hyperthermia video would be good and reactions to nerve blocks treated with fat emulsion would be good too

[@denisep6450]

Finally a great pacu focused review Thank you!

[@pacunursingminutes]

Glad you liked it! Stay tuned good content planned for 2021!

[@richardgrr3]

Thank you, my Critical Care instincts after many years are refined thru your teaching. The best.

[@pacunursingminutes]

Thanks Rich that means a lot! 😊

[@heidieho2980]

Mega informative!!! What an intensive process

[@blujean912]

With regards to Anesthesia “sign-outs”, I worked in a big organization where Anesthesia sign outs were “formal” then it became informal due to staffing issues and the time it takes to get a sign out. And we can’t have CRNAs sign the pts out. Now, I’m working in a different organization where we don’t need Anesthesia sign-outs anymore. Based on the PACU nurse’s assessment, when pts meets criteria, we can send them to phase ll or send them to the floor. I believe this provides a better pt experience and pt satisfaction.

[@pacunursingminutes]

Yes Blu Jean, every organization is different in their process of "signing-out" of anesthesia or ending this phase of care, however CMS does have guidelines around the process that every institution needs to adhere to for CMS participation. Anesthesia has a 48 hour window to chart on the case and provide a completion note of anesthesia services, which is a set of outcome questions set by CMS. This 48 hour window allows the pt to move through the phases of care with minimal delay. PADSS is the nursing way of scoring a pt ready for discharge, and the scoring systems used vary with each institutions guidelines.

[@laurenbacon5787]

Taking my cpan certification in a few months and these videos are helpful!! Thanks so much!

[@pacunursingminutes]

Hi Lauren I’m pretty close to finishing a Certification review course if you’re interested go to my website PACU nursing minutes.com to sign up for updates I’ll be releasing one here in the next few weeks pre-sale should happen soon before the end of school year!

[@sofiaanne1349]

Excellent video, thank you!!

[@pacunursingminutes]

Thank You Sophia!

[@nauticalstripes25]

Such a great video! Thank you!! I look forward to more

[@pacunursingminutes]

You are so welcome! Drop me a message of what you would like reviewed.

[@olympialopatin1115]

Can you go little slower and perhaps more visual aids. Do you recommend any books to help

[@pacunursingminutes]

HI! I recommend, ASPAN's Core Curriculum textbook and Drains Perianesthesia nursing. Thank you for the feedback! Future visual aids to come!

[@charmsmith7176]

What is your practice when you receive a pt in deep sedation with an OPA in pacu that has had back surgery? I typically will ask the OR nurse or CRNA to help me logroll the pt to check the incision. I have a more senior coworker in the department that says you absolutely cannot turn a pt with an OPA.

[@pacunursingminutes]

Hi Charmei, Great Question! Part of your initial assessment is always checking the surgical site with the OR, RN to identify early bleeding that could lead to a spinal epidural hematoma formation, in a back surgery this could lead to paralysis if not early identified and surgically corrected. If the patient awakes with a gentle turn, then great they just recovered their gag reflex and can now protect their airway. I once had a SEH that had to return to the OR thankfully they recovered full function but the patient progressed from excruciating to pain to no pains and full paralysis. Your practice is correct.

[@Fifi-np6px]

Hi Cathy thank you so much for these informative videos!!! Do you recommend any additional books/resources for newbies in the PACU area?

[@pacunursingminutes]

Hi Fifi! Yes, there are a few key resources for all Pacu nurses, Drains and ASPANs core curriculum text. Drains is writing in paragraph format and easier to understand than the core curriculum which is in outline format. Both are a great resource every Pacu should have them available for review. Ask your manager or educator. I’ve just completed a certification review course which is very comprehensive too and in video webinar format, check it out the CPAN certification review course video released 2 weeks ago. Happy studying a workbook is coming this fall to accompany the review course! Sign up at pacunursingminutes.com for updates.

[@stephenmarcus9601]

There was a inchemic RMCA stroke in and another nurse felt the patient was allowed to stay under too long without intervention. That the nurse was lax...any insights?

[@pacunursingminutes]

Hi Stephen, you never know when a clot will occur and cause an ischemic event such as a stroke. Before working in the PACU I worked in Neuro IR and one time a clot formed right intra procedure you cloud actually see the clot grow/form on the 3-D Angiogram, an embolic stroke right in front of our eyes! Even With heparin on board! You just never know when it’s going to happen but it’s always important to be vigilant with your patience postop always assessing and reassessing!