Operative hysteroscopy with intravascular absorption syndrome — emergency recognition and management station

Team-based emergency station: intravascular absorption syndrome (TURP-like syndrome) recognition and management, glycine hyponatraemia correction with hypertonic saline 3% and controlled correction rate, uterine perforation recognition, and structured handover. Includes assessor key and marking domains.

Prompt

You are the gynaecology registrar in theatre performing an operative hysteroscopy with a monopolar resectoscope and glycine 1.5% as the distension medium for a 2 cm FIGO type 0 submucous fibroid in a 44-year-old. At the 20-minute mark, the patient begins to vomit, becomes restless, complains of visual disturbance, and her blood pressure rises to 160/95 mmHg with bradycardia 50 bpm. The fluid deficit reads 1500 mL. The examiner will feed you a sequence of events.

Station brief

Format. Emergency management station, approximately 12 minutes. You are the gynaecology registrar in theatre. A scrub nurse, anaesthetist and circulating nurse are with you. The consultant is in the next theatre and reachable within minutes. The assessor will run the clock and feed you a sequence of intraoperative events.^[1]^[2]

Candidate instruction. Lead the management of a patient who develops signs of intravascular absorption syndrome during operative hysteroscopy with glycine. Verbalise your actions, the deficit limits, the recognition of the syndrome, the correction of hyponatraemia, and the structured handover to the consultant.^[3]^[1]

References3Show

[1]Shokeir T, El-Lakkany N, Sadek E, El-Shamy M, Abu Hashim H An RCT: use of oxytocin drip during hysteroscopic endometrial resection and its effect on operative blood loss and glycine deficit. J Minim Invasive Gynecol, 2011.PMID 21571595
[2]Giacobbe V, Rossetti D, Vitale SG, Rapisarda AM, Padula F, Laganà AS, Palmara VI Otorrhagia and Nosebleed as first signs of Intravascular Absorption Syndrome During Hysteroscopy: From Bench to Bedside. Kathmandu Univ Med J (KUMJ), 2016.PMID 27892449
[3]De Silva PM, Smith PP, Cooper NAM, Clark TJ Outpatient Hysteroscopy: Green-top Guideline no. 59. BJOG, 2024.PMID 39160077

Operative hysteroscopy with intravascular absorption syndrome — emergency recognition and management station

Station brief

References3Show

[1]Shokeir T, El-Lakkany N, Sadek E, El-Shamy M, Abu Hashim H An RCT: use of oxytocin drip during hysteroscopic endometrial resection and its effect on operative blood loss and glycine deficit. J Minim Invasive Gynecol, 2011.PMID 21571595
[2]Giacobbe V, Rossetti D, Vitale SG, Rapisarda AM, Padula F, Laganà AS, Palmara VI Otorrhagia and Nosebleed as first signs of Intravascular Absorption Syndrome During Hysteroscopy: From Bench to Bedside. Kathmandu Univ Med J (KUMJ), 2016.PMID 27892449
[3]De Silva PM, Smith PP, Cooper NAM, Clark TJ Outpatient Hysteroscopy: Green-top Guideline no. 59. BJOG, 2024.PMID 39160077