• Table of Contents
• Emergence

     XVI. Transport

       A. Avoid putting the patient on the transport bed
          backwards.

       B. Transport the patient with Oxygen and Monitors.

            1. It is easy to forget to turn the O2 on.
               Check the Ambu-bag prior to transporting
               the patient.  Listen to the mask to insure
               that the O2 is flowing.  A rate of at least
               6 liters/min. is required for good
               oxygenation. Setting the flow lower than
               6 l/m results in a delivered FIO2 less than
               just room air. 

       C. Bring syringes of vasoactive drugs with you to
          the PACU.

       D. If you think you will need nitroprusside on arrival
          in the PACU, mix it up before you go. This is
          especially true for the patient that is left
          intubated and anesthetized until the end of the
          procedure. These patients may initially appear
          normal but will manifest a tremendous
          hypertension by the time they reach the ICU.

       E. EVD's and lumbar drains must be clamped prior
          to transport.   


    XVII. PACU Management

       A. The surgeons may ask for naloxone in the PACU if
          the patient is not responsive. This will be the
          last step prior to going to the CAT scan.
          Discuss with whether the endotracheal tube is to
          be removed or left in place if the patient
          wakes up as he may start bucking.

            1. Plum and Posner signs of Coma and naxolone

       B. Blood pressure goals in the PACU

            1. Case specific

            2. If you are using naloxone in the PACU  to
               maintain the BP, then some questions may
               need to be answered.

                 a. cuff versus A-Line

                 b. Systolic vs mean in the case of
                    abnormally wide pulse pressures. 

       C. SIADH

       D. Diabetes Insipidus

            1. Distinguishing mannitol diuresis from DI.

       E. Start inspiratory spirometry in the recovery
          room.

       F. Nausea

            1. Droperidol .625mg IV, if no response after
               repeat doses then metoclopramide 10mg. The dose
               of ondansetron is 8mg.  Compazine can be used with
               the caution that the seizure threshold is
               lowered and alpha blockade can cause hypotension