Post anaesthetic care nursing was viewed for many years as the ‘poor relation’ of theatre and anaesthetic nursing. This was for a number of reasons, but primarily because recovery of the anaesthetised patient was, until relatively recently ward based. However with the advent of anaesthesia becoming more ‘high tech’ the skill required to look after a patient post anaesthesia has increased and with that increase the need for a high level of education for nurses within this speciality. There is now a long English National Board course for the Post anaesthetic care nurse, and opportunities are arising for nurses working in this area to add to the body of knowledge in post anaesthetic care nursing.

This article is the first in a series which will explore the identification and management of cardiac arrhythmias within the peri-operative care setting. To improve patient safety, the number of patients who are monitored within the recovery room is rising, whilst cardiac monitoring remains a fundamental requirement for patient care during the anaesthetic phase. Therefore, the role of the peri-operative care nurse requires an ability to interpret cardiac arrhythmias and to subsequently instigate the appropriate management.

The purpose of this preliminary article is to establish the basic principles that underpin the identification and management of arrhythmias. Cardiac physiology is reviewed and then applied to the derivation of the waveforms of the normal ECG. The article continues with a summary of accurate electrode placement and some tips for troubleshooting in the presence of ‘artifact’. A systematic analysis tool, which can be easily applied to clinical practice, completes the article.

Britains older population is on the increase. Anecdotal evidence suggests that the perioperative care of older patients does not take into consideration the physiological changes that come with ageing and their implications for care. Active consideration of physiological changes can contribute to the reduction in morbid events and achieves a better outcome for the older surgical patient.