The PACU Cheat Sheet Every New Nurse Needs
Bookmark this page. Everything below is what we wish had been laminated and stuck to our badge on day one — Aldrete scoring, reversal agent doses, the top 10 post-op complications and their first-line fixes, and the exact handoff report format that will make you sound competent from week one.
Aldrete score — discharge from Phase 1
Score 0-2 in each of five categories: Activity (2 = moves all extremities, 1 = two, 0 = none). Respiration (2 = deep breathe + cough, 1 = dyspnea, 0 = apneic). Circulation (2 = BP within 20% preop, 1 = 20-50%, 0 = >50%). Consciousness (2 = fully awake, 1 = arousable, 0 = not responding). O2 saturation (2 = >92% RA, 1 = supplemental O2 needed, 0 = <90% with O2). Discharge criteria: score ≥9.
Reversal agents — dose and watch-out
Naloxone (opioid): 0.04-0.4 mg IV titrated. Watch for re-narcotization — it's shorter-acting than most opioids. Flumazenil (benzos): 0.2 mg IV over 15 sec, repeat q1 min up to 1 mg. Can seize in chronic users. Sugammadex (roc/vec): 2-4 mg/kg IV. Watch for anaphylaxis, bradycardia. Neostigmine + glycopyrrolate: 0.04-0.07 mg/kg + 0.2 mg glyco per 1 mg neo. Watch for bradycardia and bronchospasm.
Top 10 post-op complications and first move
1) Airway obstruction → jaw thrust, airway adjunct. 2) Laryngospasm → PPV 100% O2, propofol. 3) Hypoxia → 100% NRB, sit up, suction. 4) Hypotension → fluid bolus, phenylephrine. 5) Hypertension → pain control, labetalol/hydralazine. 6) PONV → ondansetron 4mg IV, add dexamethasone. 7) Shivering → warming, meperidine 12.5-25mg. 8) Pain → titrate short-acting IV opioid + multimodal. 9) Delirium → orient, treat pain/urinary retention, dexmedetomidine. 10) Bleeding → hold pressure, call surgeon, T&S ready.
SBAR handoff — memorize the shape
S — 'Mr. Smith, 62, POD 0 lap chole.' B — allergies, home meds, PMH, pre-op vitals. A — current vitals, pain, lines/drains, last meds, I/O, mental status. R — 'He's ready for the floor; next Norco due at 1400, pending amb + void, follow-up with surgeon in 2 weeks.' Read back any verbal orders.
Want the printable version + full study bundle?
The Baddie RN PACU bundle includes this cheat sheet, drug cards, a workbook, and access to the private nurse community.
Get the PACU bundle →FAQ
How do I remember all this on shift?
Print this page or save it to your phone home screen. Most PACU nurses also keep a badge card with reversal doses and Aldrete scoring for the first six months.
What's the difference between Phase 1 and Phase 2 PACU?
Phase 1 is immediate post-anesthesia recovery — 1:2 ratio, continuous monitoring. Phase 2 is step-down or discharge prep — 1:3 ratio, focus on ambulation, PO, void, and teaching.