Cliff Schmiesing, MDSuma Ramzan, MD
Department of Anesthesia
StanfordUniversitySchool of Medicine
June 13, 2006
Dear PACU resident,
Welcome to the PACU rotation. We look forward to working with you over the upcoming rotation. This booklet contains information that will be helpful to you. Please review the PACU Goals and Objectives and Teaching Objectives early on in order to focus your learning.
We have included what we think are important learning objectives. Many of the topics are covered in the reading materials in this booklet including papers dealing with discharge criteria, and what patients experience during the week following ambulatory surgery. Some topics such as airway management are well covered in the standard texts. We think it is important to develop an approach to problems commonly encountered in the PACU just as you do in the OR. Residents in the past have not routinely managed problems in the PACU. We have learned more about PACU care as an attending than we did as a resident. However, this is an important aspect of the practice of anesthesia, especially in private practice where you can be responsible for patients in the PACU while involved in cases in the OR. Although you will be arriving at 7:30am in the PACU you may not see any PACU patients until a short while later. This time is meant to be utilized as reading time and self directed learning. Use this time to read over the journal articles provided to you in this booklet.
You will see a variety of PACU management issues. After you take report from the primary anesthesia team upon the patient’s arrival to the PACU, you will be the physician responsible for all issues (i.e. PONV, CXR for line placement, hypotension, inadequate epidural pain relief) therefore you must be in the PACU and readily available outside of morning/lunch/afternoon breaks. You will be responsible for epidural orders and giving information about these patients to the Pain service, who will follow the patients on the wards. You will need to prepare a PACU case report at the conclusion of the rotation based on a case during your rotation.
During your professional career you will often find yourself giving in-service talks to educate the members of your perioperative anesthetic team. With this in mind, we ask that you prepare a 10 minute in-service talk on any topic for the PACU nurses to be given during the 2nd week.
During your rotation keep a log of all procedures performed. These can include placement of arterial lines, epidurals or peripheral nerve blocks to name a few.
Please note that if you need help or support urgently, you should call the attending who was part of the patient’s primary OR anesthesia team. If he/she is unavailable, then you can call the scheduler at x6-0249. After 5pm please sign out any ongoing issues to the 1st call attending. Please let us know early on about any problems you encounter. The sooner we know about them, the sooner we can help try and resolve them. We look forward to working with you!
Cliff Schmiesing, MDSuma Ramzan, MD
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