Original Publication
Open Access

Unresponsive Patient in the Post Anesthesia Care Unit

Published: January 29, 2015 | 10.15766/mep_2374-8265.10005

Included in this publication:

  • A Instructor Guide-Unresponsive 2015.docx
  • B Scenarios-Unresponsive 2015.docx
  • C Technical Guide-Unresponsive 2015.docx
  • D Debriefing Document-Unresponsive 2015.docx
  • E Evaluation Form-Unresponsive.docx

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


Anesthesia providers are required to provide care across the spectrum of the perioperative period. This includes preoperative evaluation and also postoperative care. This simulation series helps learners explore a common problem in the recovery room and consider diagnoses and strategies for dealing with it. Specifically, this simulation consists of four scenarios dealing with the unresponsive patient in the postanesthesia recovery unit (PACU). The front story of the patient is nearly identical for the four scenarios, but there are four possible causes to be explored. These can be done in sequence on the same day or on different days, depending on the time available. It functions as a tool for training, evaluating, and reinforcing material learned in the classroom and operating room, and is applicable for trainees at many different levels. This training module has the potential to identify weaknesses in a learner's approach to care within the postoperative period, which is a skill examined by the American Board of Anesthesiology Oral Exam. At our institution, we have found that both resident and student nurse anesthetists had some background and approach to the care of these simulated patients, but did not fully understand the systems limitations or how to fully integrate care across specialties.

Educational Objectives

By the end of this session, learners will be able to:

  1. Identify and manage perianesthetic complications of an unresponsive patient in the postanesthesia recovery unit (PACU).
  2. Identify and manage the following crises: (1) acute hypercarbic respiratory failure secondary to opioid-induced respiratory depression or residual neuromuscular blockade, (2) opioid induced respiratory depression, (3) residual neuromuscular blockade, and (4) Acute severe hypoglycemia.
  3. Perform ventilation with one of the following: (1) a face mask and Ambu bag, (2) a face mask and transport bag, (3) a supraglottic airway and reservoir bag, or (4) intubation and reservoir bag.
  4. Perform neuromuscular stimulation to assess for residual neuromuscular blockade.
  5. Describe the causes of an unresponsive patient in the PACU.
  6. Analyze and discuss their management of the unresponsive PACU patient during the debriefing to determine knowledge gaps and areas for improvement.
  7. Behave in a professional manner while receiving feedback.
  8. Provide constructive feedback to the simulation team running the scenarios.
  9. Communicate with and delegate tasks to the PACU nurse during simulation crises listed above.

Author Information

  • Christina Spofford, MD, PhD: University of Iowa Roy J. and Lucille A. Carver College of Medicine
  • David Easker, MD: University of Iowa Roy J. and Lucille A. Carver College of Medicine

None to report.

None to report.


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Spofford C, Easker D. Unresponsive patient in the post anesthesia care unit. MedEdPORTAL. 2015;11:10005. https://doi.org/10.15766/mep_2374-8265.10005