ACPAN NATIONAL CONFERENCE 2018 Preparing for Perianaesthesia Emergencies Dr Paula Foran, PhD, Master Professional Education & Training, FACORN, FACPAN Chief Examiner ACPAN Education Officer ACORN Perianaesthesia subject co-ordinator CNA532, CNA534 University of Tasmania

Some say you cannot prepare for an emergency ACPAN NATIONAL CONFERENCE 2018 Preparing for Perianaesthesia Emergencies ! Image Holy Spirit Hospital Some say you cannot prepare for an emergency

ACPAN NATIONAL CONFERENCE 2018 ! ACPAN NATIONAL CONFERENCE 2018 Preparing for Perianaesthesia Emergencies Image Crossgates | NextGen

ACPAN NATIONAL CONFERENCE 2018 Preparing for Perianaesthesia Emergencies ! In the operating room, the importance of establishing perioperative team training is essential from the viewpoints of crisis management and resuscitation (Komasawa 2016) Image GED 578 - Alternative Learning Environments Simulation Training

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As you are preparing for the day, think of possible emergencies ACPAN NATIONAL CONFERENCE 2018 Preparing for Perianaesthesia Emergencies ! Image Day 10 Internet As you are preparing for the day, think of possible emergencies

ACPAN NATIONAL CONFERENCE 2018 Preparing for Perianaesthesia Emergencies ! Difficult airway and major airway complications occurring in both the ICU and operating suites involving obese patients were 47% and 40%, respectively ( De Long 2015) Image Lessons Learned with Check-in You are making a nursing assessment: does this patient have risk factors?

Discuss plan A & B with your anaesthetist ACPAN NATIONAL CONFERENCE 2018 Preparing for Perianaesthesia Emergencies ! Discuss plan A & B with your anaesthetist Image Pediatric EM Morsels

Know your rapid infuser ACPAN NATIONAL CONFERENCE 2018 Preparing for Perianaesthesia Emergencies ! Image Pond 5 Know you hospital policy for emergency situations, for example massive transfusion Know your rapid infuser

In every LUSCS prepare for possible bleeding ACPAN NATIONAL CONFERENCE 2018 Preparing for Perianaesthesia Emergencies ! Image 9Coach - Nine In every LUSCS prepare for possible bleeding

At the start of each shift – allocate tasks for CPR ACPAN NATIONAL CONFERENCE 2018 Preparing for Perianaesthesia Emergencies ! in charge – senior nursing staff to take charge of arrest and do defibrillation ventilation chest compression scribe Image NSW First Aid | Perform CPR At the start of each shift – allocate tasks for CPR

WELCOME TO PACU Invented by surgeons

PACU nurses have a specific and unique skill set ACPAN NATIONAL CONFERENCE 2018 Preparing for Perianaesthesia Emergencies Nurses in PACU are specially trained to manage and care for patients during this vulnerable period and to promptly summon assistance from expert medical staff (the anaesthetist or surgeon) when required (Foran 2016). The PACU nurse role is to provide a high standard of expert nursing care to patients in this specialist area until their condition has stabilised to a point where they are considered ‘ward ready’ (Foran 2016; Foran & Marshall 2015). PACU nurses have a specific and unique skill set

What are the possible complications? If you are unsure ask!!! ACPAN NATIONAL CONFERENCE 2018 Preparing for Perianaesthesia Emergencies What are the possible complications? If you are unsure ask!!! There are many general complications of surgery, however there are often specific complication to each different type of surgery

We can put a man on the moon but we can’t always prevent N&V ACPAN NATIONAL CONFERENCE 2018 Preparing for Perianaesthesia Emergencies ! We can put a man on the moon but we can’t always prevent N&V

ACPAN NATIONAL CONFERENCE 2018 Preparing for Perianaesthesia Emergencies ! Image Psychology Today Shock is a condition of circulatory impairment leading to inadequate vital organ perfusion and oxygen delivery

Hypoxaemia ACPAN NATIONAL CONFERENCE 2018 Preparing for Perianaesthesia Emergencies ! Hypoxaemia Image Irish Times

ACPAN NATIONAL CONFERENCE 2018 Preparing for Perianaesthesia Emergencies ! • 45% of intra-op patients & 77% of post-operative patient did not receive active warming when required • Contrary to recommended practice 47% of patients were hypothermic at discharge from PACU • The audit revealed poor compliance with evidence based recommendations (Duff 2014) • Hypothermia is associated with increased mortality rates (Billeter et al. 2014) • In elective operations there was a 4-fold increase in mortality • Doubled complication rate (sepsis & stroke has the greatest increase) (Billeter et al. 2014) Hypothermia

Be watchful for the complications of surgery ACPAN NATIONAL CONFERENCE 2018 Preparing for Perianaesthesia Emergencies ! Be watchful for the complications of surgery Know every complication and look out for it

Care to be accurate What do others say when a heart rate is low??? Tides of Change: An Exciting Future for Perianaesthesia Nursing, Let’s make it happen! What do others say when a heart rate is low??? Do you see people taking lots of different temperatures?? What is the ‘go to’ statement for a pre-op blood pressure if it is low compared to the baseline????? Care to be accurate Images Ted Hyunhak Yoon

How do we take a respiratory rate? Over 1 full minute Respiratory observations are the neglected vital sign (Cooper & Buist 2008; Cretikos, Bellomo & Hillman 2008) Despite the fact that they are a reliable predictor of life threatening clinical adverse events (Cooper & Buist 2008; Cretikos, Bellomo & Hillman 2008)  Analysis performed in 2007 revealed that out of 576 reported hospital deaths, 11% were due to deterioration of the patient without recognition or treatment (Lomas & West 2009) Whilst the mortality in surgical patients has fallen in the last decade, mainly due to effective recognition and treatment of patient deterioration, failures in this process are still occurring (Helling et al. 2014).

ACPAN NATIONAL CONFERENCE 2018 Preparing for Perianaesthesia Emergencies !

Discussion ACPAN NATIONAL CONFERENCE 2018 Preparing for Perianaesthesia Emergencies ! Discussion