Hysteroscopy

Question 1

uterine pressure for adequate visualization

Answer 1

60-80mmHg - Pasic

Question 2

vasovagal syndrome

Answer 2

hypotension bradycardia n/v diaphoresis pallor LOC

Question 3

mgt of vasovagal syndrome

Answer 3

stop, take vital signs, check ABC, place patient in tendelenburg position
if still brady: give atropine 0.5mg IVq3-5 mins max 3mg

Question 4

absolute contraindications t0 hysteroscopy

Answer 4

pregnancy
active pelvic infection including genital herpes
cervical cancer

Question 5

fluid overload in healthy woman

Answer 5

1000ml hypotonic
2500ml isotonic

Question 6

fluid overload in elderly or with co-morbids

Answer 6

750ml hypotonic
1000ml isotonic

Question 7

systemic fluid absorption factors

Answer 7

intrauterine pressure
MAP
depth of myometrial penetration (size of myoma or septum)
duration of surgery
size of uterine cavity
partial perforation

Question 8

dilutional hyponatremia <125mmol/L ssx

Answer 8

headache, nausea, vomiting, weakness

Question 9

na< 120 mmol/L

Answer 9

confusion lethargy seizures coma arrhythmia bradycardia respiratory arrest

Question 10

mgt hyponatremia

Answer 10

insert catheter
measure electrolytes, urea, crea
furosemide 40mg IV
correct hyponatremia: 3% hypertonic NaCl 1-2mmol/L/h
or bolus 100ml 3% NaCl over 10 mins x 3 doses
do 12L ECG and cxr
multidisciplinary team

Question 11

goal of hyponatremia correction

Answer 11

6mmol/L over 24 hours until 130mmol/L

Question 12

hyponatremia –> _____
rapid correction of Na —> _____

Answer 12

1) cerebral edema
2) pontine myelinolysis

Question 13

air embolism ssx

Answer 13

sudden fall of O2
dec end tidal CO2 volume
hypootension
tachycardia
metallic heart/mill-wheel murmur
confirmed by 2d echo or TEE

Question 14

prevention of air embolism

Answer 14

avoid trendelenburg
leave dilator in
purge air from inflow tube
minimize in-out
outflow suction 80-100mmHg
avoid non-collapsible distention media containers

Question 15

air embolism

Answer 15

stop procedure/gas
ventilate with 100% oxygen
turn patient to left (durant maneuver)
insert CVP and aspirate air
hyperbaric chamber

Question 16

indication of laparoscopic exploration in uterine perforation

Answer 16

bowel injury suspected
large defect
heavy bleeding
perforated with active electrode