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Being The Post Anesthesia Care Unit (PACU) Resident

Last week, I was the resident in charge of overseeing the post anesthesia care unit (PACU). Every morning, I checked the stat room to make sure it was set up for an emergent case and performed an inventory on our airway boxes for stat intubations around the hospital. Then I proceed to the pre-op area to help my colleagues prepare for their first cases by placing IVs, charting, etc.

So what’s PACU like? There’s usually a quiet period from 7:30 – 9:00 AM as most cases are still in progress, but the action soon follows. As patients roll back to the PACU, I obtain a brief history from the anesthetic provider and manage the patient till their post-operative symptoms are well controlled (pain, nausea, etc.), their vital signs are at baseline (namely blood pressure and oxygenation), and they have not shown signs of operative complications like inadequate hemostasis. This post-operative evaluation window can last anywhere from minutes for straightforward cases to nearly six hours for post-embolization patients. Once I’ve deemed the patient stable for discharge or transfer, I’ll contact the attending anesthesiologist for that particular case, and they’ll sign off the encounter.

The problem is when numerous responsibilities are compounded all at once. If a stat case rolls back to the operating room, I’m in charge of preparing that anesthetic. If code blues or stat intubations are called across the hospital, I’m the resident who responds (including documentation and restocking all the equipment). In the meantime, scheduled cases are coming back to the PACU and nurses are persistently demanding sign outs from attending physicians.

I’ve had several instances this week where a stat intubation was called, and by the time I got back to the PACU, new patients had shown up. This can become stressful especially when PACU patients aren’t doing well, but it was nice having to manage post-operative patients of all kinds with minimal supervision. I’ll be the PACU resident on Monday and for a few days near the end of the month too. For now, it’s time to enjoy the weekend! 🙂

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