Fluid overload and hyponatraemia at operative hysteroscopy — emergency management station

Team-based emergency station: operative hysteroscopy intravascular absorption syndrome (OHIA) with hyponatraemia and cerebral oedema during a prolonged glycine resection. Tests recognition of a rising deficit, parallel resuscitation and sodium correction, and closed-loop communication. Includes assessor key and marking domains.

Prompt

A 54-year-old woman with hypertension is undergoing hysteroscopic resection of a large type II submucous fibroid with a monopolar resectoscope and a glycine distension medium. Forty minutes in, the fluid deficit is climbing fast and the anaesthetist reports the patient is becoming confused, with a falling serum sodium on the gas machine. You are the registrar; the consultant is in the next theatre.

Station brief

Format. Emergency management station, approximately 12 minutes. You are the gynaecology registrar in theatre. An anaesthetist and a scrub nurse are with you; the consultant is next door and available. The assessor runs the clock and feeds new observations. ^[2]

Candidate instruction. Lead the management of suspected fluid overload and hyponatraemia during an operative hysteroscopy. Verbalise your actions, your escalation triggers, and your communication with the anaesthetist, the team and the consultant. ^[2]

References4Show

[1]Munro MG, Storz K, Abbott JA, et al. AAGL Practice Report: Practice Guidelines for the Management of Hysteroscopic Distending Media J Minim Invasive Gynecol, 2013.PMID 23465255
[2]Sethi N, Chaturvedi R, Kumar K Operative hysteroscopy intravascular absorption syndrome: A bolt from the blue Indian J Anaesth, 2012.PMID 22701213
[3]Moore JF, Carugno J Hysteroscopy StatPearls, 2026.PMID 33232015
[4]Calabrese S, DE Alberti D, Garuti G The use of bipolar technology in hysteroscopy Minerva Ginecol, 2016.PMID 26928415

Fluid overload and hyponatraemia at operative hysteroscopy — emergency management station

Station brief

References4Show

[1]Munro MG, Storz K, Abbott JA, et al. AAGL Practice Report: Practice Guidelines for the Management of Hysteroscopic Distending Media J Minim Invasive Gynecol, 2013.PMID 23465255
[2]Sethi N, Chaturvedi R, Kumar K Operative hysteroscopy intravascular absorption syndrome: A bolt from the blue Indian J Anaesth, 2012.PMID 22701213
[3]Moore JF, Carugno J Hysteroscopy StatPearls, 2026.PMID 33232015
[4]Calabrese S, DE Alberti D, Garuti G The use of bipolar technology in hysteroscopy Minerva Ginecol, 2016.PMID 26928415