What do you think this condition might be?
Mrs Lucia Caruso is a 31-year-old woman who has been admitted into the postanaesthesia care unit (PACU) following a dilation and curette after having had an incomplete missed abortion (miscarriage). On arrival, Mrs Caruso has a size 3 laryngeal mask airway (LMA) in situ, and is unconscious and in a supine position. A disposable t-piece and oxygen, 6 litres per minute, are connected to the LMA and monitoring is connected.
You accept a full handover from the anaesthetist, who reports a fit and healthy patient and an uneventful procedure. An IV line is in situ in the back of the patient's left hand with a litre of Hartmann's solution running at an 8-hourly rate. You make your initial assessment and document the patient's vital signs as follows: airway clear, oxygen saturation 99%, respiratory rate 18 per minute, BP 130/90 mmHg (preoperative 120/80 mmHg) and heart rate regular at 74 bpm.
Five minutes after arrival, Mrs Caruso stirs and opens her eyes and you remove the LMA and place her on 6 litres of O2 via a Hudson mask. Now that the patient is conscious, you continue your observations, taking and recording her core temperature (using a tympanic ear thermometer) at 36.2°C and assessing the per vaginal (PV) loss, which is slight and bright.
You sit Mrs Caruso slightly head up to facilitate optimal ventilation. Mrs Caruso is understandably upset and so you comfort her. Her vital signs remain stable and so after 15 minutes you remove her oxygen and trial her on room air.
Mrs Caruso appears stable: SaO2 97% on room air, BP 115/85 mmHg, respirations 20 per minute and heart rate 70 bpm. No further PV loss is present and so you conclude that your patient is ready to be transported to the ward. You decide to record the next set of observations (due in 2 minutes) on the ward observation chart and then you will call the ward nurse to collect Mrs Caruso.
What will be an ideal response?
Answer:
Cervical shock/vasovagal shock may be produced by stimulation of the cervical canal or cervix during dilation. It is characterised by peripheral vasodilation leading to decreased BP and a bradycardia (Chen-Scarabelli & Scarabelli, 2004). This combination often results in sudden loss of consciousness (Chen-Scarabelli & Scarabelli, 2004). Although cervical shock/vasovagal shock is a rare complication following manipulation of the cervix (Brown, 2014), it must be understood and nurses in the PACU must be watchful for this occurrence.
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