Staffing, Handoff & Discharge
This is the minimum nursing-to-patient ratio required for patients during the initial recovery phase in the PACU.
What is 1:2?
This is the most common cause of delayed emergence.
What is residual drug effect (sedatives, opioids, or volatile agents)?
This is the immediate, life-saving bedside intervention for a post carotid endarterectomy patient with airway compromise (that began after PACU hand-off).
What is opening the surgical incision (evacuation of the hematoma)?
The 5th Consensus Guidelines identify this specific D2/D3 dopamine antagonist as a unique agent that is effective for both the prophylaxis of PONV and as a rescue medication for patients who failed prophylaxis with other classes.
What is Amisulpride?
A PACU patient with hypotension, high CVP, and muffled heart sounds is exhibiting this classic clinical triad.
What is Beck’s Triad (Cardiac Tamponade)?
Beyond clinical stability, an outpatient may not be discharged home without this specific social requirement.
What is a responsible adult to accompany them (and provide supervision for 24 hours)?
While advanced age is the primary risk factor, this is the most significant protective factor consistently identified in the literature for POCD
Higher baseline level of education
Unilateral injury to recurrent laryngeal nerve presents with this clinical sign.
What is hoarseness?
According to the 5th Consensus, the most effective single intervention to reduce a patient's baseline risk for PONV is the complete avoidance of this class of anesthetics.
What are volatile anesthetics?
This is the formula for coronary perfusion pressure.
What is (aortic DBP - LVEDP)?
This minimum Modified Aldrete Score that is typically required before a patient may be discharged from Phase I PACU.
What is 9?
These three specific electrolyte derangements are known to significantly potentiate and prolong the effects of non-depolarizing NMBDs.
What are hypermagnesemia, hypokalemia, and hypocalcemia?
Airway obstruction presenting as stridor or laryngospasm 24–72 hours after thyroid surgery is most likely triggered by this electrolyte derangement.
What is hypocalcemia?
This anatomical area in the floor of the fourth ventricle serves as the chemoreceptor trigger zone (CTZ) and lacks a blood-brain barrier.
What is the area postrema?
This cardiovascular reflex, characterized by bradycardia and hypotension, is often triggered by sudden decreases in preload.
What is the Bezold-Jarisch reflex?
The components of the Modified Aldrete Score.
What are activity, respiration, circulation, consciousness, and oxygen saturation?
This centrally-acting cholinesterase inhibitor can reverse the sedation, confusion of central anticholinergic syndrome in the PACU.
What is physostigmine? (crosses blood brain barrier)
This ABG finding distinguishes pure hypoventilation from dead space or shunt as the cause of PACU hypoxemia.
What is a normal A-a gradient?
This class of drugs, which includes Aprepitant and Rolapitant, is recommended for high-risk patients?
What are Neurokinin-1 (NK1) receptor antagonists?
Abrupt discontinuation of this alpha 2 agonist on the morning of surgery can lead to severe "rebound" hypertension in the PACU.
What is clonidine?
The components of the Post-Anesthetic Discharge Scoring System (PADSS).
What are vital signs, ambulation, pain, PONV, and surgical bleeding.
This clinical sign can be used to differentiate serotonin syndrome and neuroleptic malignant syndrome at the bedside.
What are hyperreflexia and clonus?
A post-thyroidectomy patient presents with acute respiratory distress and a "paramedian" vocal cord position on laryngoscopy. This indicates ______, _____ injury to this nerve.
What is bilateral complete injury to Recurrent Laryngeal Nerve?
Reaffirmed with a Grade A level of evidence in the 5th Consensus Guidelines, this non-pharmacologic intervention is documented to be as effective as a single antiemetic drug for PONV prophylaxis.
What is P6 (Pericardium 6) acupoint?
(Located between the tendons of the palmaris longus and flexor carpi radialis)
A patient is started on vasodilator infusion in PACU for management of hypertension and immediately becomes hypoxic, this physiologic mechanism is likely at play.
Hypoxic pulmonary vasoconstriction (inhibited by vasodilator)