PACU

I'm currently doing my two week rotation in the post-anesthesia care unit. Managing the recovery unit is very different than my usual operating room routine. Instead of focusing entirely on one patient undergoing surgery, overseeing the PACU reminds me of running a floor service. The majority of patients wake up fine after anesthesia and need no intervention. Some require minor assessments for pain, nausea, itching, and confusion, while others have epidural or nerve block catheters that require adjustments. But the challenge is to identify and care for those patients who are at risk for dangerous complications. Some injuries may have happened under anesthesia and been unrecognized such as a heart attack or stroke. Other problems arise as patients awake including weakness from residual paralysis, airway obstruction, and arrhythmias. Thus, the PACU teaches me how to look at the intersection of medical comorbidities, dissipating anesthetic, and recent surgery. The other aspect of the PACU is managing the flow of patient care. If all the beds in recovery are full, the bottleneck can really hamper operating room efficiency. I develop a good sense of when patients are stable to go home or to the floor. And I can't complain about the hours, since the first patient arriving in recovery is an hour after the usual operating room start time.