CST: Postoperative Care: PACU Monitoring, Handoff, and Complications

Transfer and handoff

Give a structured report (SBAR) covering procedure, anesthesia, estimated blood loss, fluids, drains, counts, implants, allergies, and any intraoperative events. In the PACU, priorities are airway, breathing, circulation, and temperature. The Aldrete score rates activity, respiration, circulation, consciousness, and oxygen saturation, each 0 to 2; a score of 8 or higher with stable vitals generally supports discharge from Phase I.

Monitoring

Watch vital signs, pulse oximetry, capnography, temperature, and level of consciousness. Adult urine output should be at least 30 mL/hour. Report drain output over roughly 100 mL/hour, sudden hypotension with tachycardia, or falling saturation to the surgeon promptly.

Recognizing complications

Malignant hyperthermia presents with unexplained tachycardia and rising end-tidal CO2 earliest, then masseter or generalized rigidity and hyperthermia. Stop triggering agents, give 100% oxygen, call for dantrolene, and begin cooling. Hemorrhage shows as hypotension, tachycardia, decreasing hematocrit, and brisk drain output. Atelectasis is the classic cause of fever in the first 24 to 48 hours; pneumonia and urinary infection appear around days 3 to 5, wound infection around days 5 to 7, and deep vein thrombosis later. Dehiscence is described as a popping or "something gave way."

Wound care and education

Maintain aseptic technique at dressing changes. Reinforce a saturated dressing rather than removing the surgeon's dressing without an order, and document the character and amount of drainage. Teach pain control, incentive spirometry, early ambulation, incision care, and signs of infection, and confirm follow-up.

Traps: attributing a first-postoperative-day fever to wound infection; giving oral fluids before protective reflexes return; dismissing a small but rising drain output trend.

Example: a PACU patient with BP 88/50, HR 122, and 150 mL drain output in 30 minutes needs immediate surgeon notification and likely fluid resuscitation.