It’s official. I am in love with the PACU. Post anesthesia care unit, that is.
Basically, this unit a is fast paced, on your toes, better know your P’s and Q’s kind of place. That’s where I went today with two other classmates. It was amazing.
Here’s how it works. There are 12 beds open. Today, they were short a nurse so we were working 8 beds. Patients roll in from the Operating Room to the PACU because that is the recovery room. Each nurse gets two beds. The first patient goes to bed 1, second patient goes to bed 3, then 5, and 7. After each nurse gets their first patient, it goes around again on the even numbers.
PACU patients are ideally there for an hour or so before being transferred out, although they are often in the unit longer for various reasons.
Patients that go home same day may go the ambulatory care area to meet with family and finish getting things settled before leaving. Patients going to the floor may have to wait in PACU until they get a bed. The other reason for the longer wait time is if the patient is unstable.
Vital signs are checked every 15 minutes and your assessments better be spot on. You also have to maintain fluids going in and make sure the dressings from surgery are dry and intact. If there is too much oozing or bleeding, you’ve got to notify the right people and potentially roll them back. Depending on what kind of surgery they had, your assessment focus changes. For example, a patient with back surgery, you want to make sure they can move their legs and still have sensation while a heart patient, you’re monitoring their rhythm strips. Those are some basic examples.
The neat thing about PACU is that it starts off slow where you’re doing nothing. Well, that bit is the only dull bit. As soon as the first surgery rolls in, you hit the ground running. The patient rolls in and you jump in. Someone is charting while someone else is hooking up their leads to the monitor while someone else is hooking up the oxygen. The level of teamwork is amazing.
The PACU nurses are unbelievable. They’ll be taking report from the CRNA (certified registered nurse anesthetist) and listening to the various people calling out data and charting it all at the same time. They can listen to the breath sounds to see if they’re clear or wheezing, crackling, etc while counting how many breaths they take in a minute at the same time. A task a lot easier than it sounds.
“Pt X came in a for an inguinal hernia repair this morning and is under general anesthesia. There-”
“36.4 is temp!”
“- estimated blood loss is 5ml and-”
“12 respirations, clear and equal!”
“they’re on 8L of oxygen non-rebreather mask. They”
“BP 134/83 and there’s an 18 gauge needle in the left hand!”
” have a history of smoking and asthma. Their pre-op BP was 145/95 and they”
“Dressings dry and intact.”
“were given Ancef 1gm at 0850”
That’s just an example of a report from CRNA and call-outs from the ones assessing all happening at the same time. And it all happens in about five minutes. Then you follow it up with a more in-depth look and then reassess every 15 minutes. Plus, you could have another patient to tend to at the same time.
The other thing is that when you wheel a patient out, you could come back to another one rolling in. So fast paced! I adore the fast paced environment. And everyone is so knowledgeable there. You’re always learning and seeing new surgeries or new doctors who do the surgeries in different ways. Truly fascinating.
What else is fascinating? The way people respond to anesthesia. HILARIOUS. That’s a post for another day though.
Today was busy and I got to do more today clinically than ever before. We’re taking it to a new level and today, I finally started feeling like more of a nurse and less of a NA (nursing assisstant).
I did a straight catheter for the first time on a male (human, not a dummy), an Accucheck to test glucose, prime the tubing on a drip (medication that flows through an IV), change the tubing on a drip already hung, and learned how to/successfully put on EKG leads. And then, of course, all the normal assessment things.
I also saw some neat drains that you only see straight out of surgery. There’s one drain that pulls blood out and once it’s full, you flip it and retransfuse it back into them. So awesome.
I’m back there tomorrow starting late!! The other nice thing about PACU, they are the latest starting clinicals. I don’t have to arrive until 7.30 so that I can change into my scrubs and be on the floor at 8. Hello, luxury.