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Introduction
Importance of PACU Adequate preparedness Sudden complication
History of PACU
1947: Anaesthesia Study Commission report Experience of trauma management in 2nd World War Advances in Surgery in 50s and 60s Day care surgery concept of the 90s
Design of PACU
Location:
Close to Operating Rooms Easy access to Lab, X-ray, Blood bank Close to ICU
Size:
Ideal 1.5 PACU bed for every OR 120 square foot per patient Minimum of 7 feet between beds
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Design of PACU
Facilities:
Fowlers cot with side rails Piped Oxygen, Vacuum and Air Multiple electrical outlets Large doors Good lighting Isolation for Immuno-compromised patients
Equipments in PACU
Tray with labeled Emergency drugs Airway maintenance kit:
Laryngoscope with all size blades All sizes Endotracheal tubes Face masks, Airways, Ambu Bag, Venturi masks Tracheostomy set ICD set Transport ventilator
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Equipments in PACU
Personnel:
Requirement varies 1 : 1 ratio good 1 : 3 ratio acceptable for busy ORs
Monitors:
ECG Pulse oximeter Non invasive BP EtCO2 Invasive pressure monitor Temperature
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Transportation to PACU
Fowlers cot with side rails Patient handed over to PACU nurse by the Anaesthesiologist
Care in PACU
Monitoring : ECG, SpO2, Blood pressure Oxygen therapy Pain therapy, anti-emetics Blood Pressure recording:
Every 5 minutes for 30 minutes Every 15 minutes for next 30 minutes
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Laryngeal Spasm:
Due to secretions Due to irritable airways (smokers)
Rx: 100% Oxygen through face mask Hydrocoritsone 100 mg IV If no improvement rapid intubation to secure the airway
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Hypoventilation:
Inadequate N.M. blockade recovery Respiratory depressant effect of volatile agents, narcotics, benzodiazepines Hypocarbia intra operatively Upper abdominal incisions
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Pnemothorax:
following rib injury following CVP placement
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