TEMPLATE DESIGN © Introducing STOPPIT as a mnemonic for managing vaso-vagal attacks in outpatient gynaecology clinics. O O Ajibona. Department of Obstetrics and Gynaecology, Sandwell and West Birmingham NHS Trust. UK Objectives Results continued… Conclusions References Methods This small survey of 28 clinicians has revealed an educational need. STOPPIT suggests an emergency drill response as follows:- Stop, Talk to the patient, Observe, Position, Pulse and pressure, Intravenous access, Team. As the mnemonic states :- The clinician must STOP the procedure immediately. TALK to the patient to reassure her and to:- OBSERVE her response POSITION patient by elevating legs/head down PULSE and PRESSURE measurements should be performed. To introduce an easy to remember mnemonic to competently treat vaso-vagal attacks associated with gynaecological procedures in the outpatient setting. Figure 1 represents the clinician’s first response to the vaso-vagal attack. The common management strategies mentioned irrespective of sequence is illustrated in Fig 2. Fig 3 shows variation in positioning advocated by the 23 out of 28 clinicians who would reposition patient at some point in the patients management. Fig4 illustrates drug types advised by the 5 out of 28 clinicians who mentioned IV drugs as a management strategy. 1.Natalie A M Cooper, Khalid S Khan, T Justin Clark. Local Anaesthesia for pain control during outpatient hysteroscopy: systematic review and meta- analysis.BMJ2010;340:c Royal College of Gynaecologists and Obstetricians/British Society of Gynaecological Endoscopists Joint Guideline. Best Practice in Outpatient Hysteroscopy. March clinicians were subjected to a short verbal interview consisting of three questions. These were:- 1.Has your patient ever had a vaso-vagal attack while undergoing a gynaecological outpatient procedure? 2.What should the response be in the event of a patient having a vaso-vagal attack? 3.Have you ever received any training on what to do in the event of a patient suffering from a vaso-vagal attack under these circumstances? All the responses were unprompted and documented as stated. All the clinicians were involved in procedures such as endometrial biopsies, the insertion of Mirena intrauterine systems©, Hysteroscopies, Novasure endometrial ablations© and Versapoint polypectomies© in the outpatient setting. Disclaimer: The management of vaso-vagal attacks stated are the views of the author and this is not a clinical guideline. Ambulatory procedures will continue to have a more prominent role in the future of Gynaecology. It’s advantages of enhanced patient safety by avoiding general anaesthesia and allowing the more judicious use of hospital resources such as inpatient beds, operating theatre time, staff and money will ensure this. It is now becoming unusual to perform routine diagnostic hysteroscopies under general anaesthesia as in the past and more therapeutic procedures can and are being performed under a local anaesthetic. Vaso-vagal attacks in outpatient hysteroscopy are continually reported in the literature. Most publications address the prevention of vaso-vagals but do not address what to do in response to one actually occurring despite adequate preventative steps(1,2). As the volume of outpatient clinic procedures increase and as more prolonged invasive procedures are performed they are more likely to be encountered. This being the case it is imperative to raise the clinicians awareness and to have in place a simple emergency drill in the event of a vaso-vagal attack in outpatient clinics in which such procedures are performed. Conclusions continued..Results continued … Fig 1 First Response Fig 2 Management Strategies IV ACCESS for atropine if not recovering sufficiently within a few seconds. The indicated pulse value suggested varies but a common threshold for atropine administration is a pulse of under 40bpm. The usual dosage is 500mcg IV slowly. Call TEAM if insufficient response to atropine or at any time and immediately in cardio-pulmonary arrest. The team may be the Emergency response or Resuscitation team in a hospital setting or ambulance/paramedics in an off hospital site clinic. Basic life support measures should be instituted as needed pending team arrival. Results 14 out of the 28 clinicians’ patients had suffered a vaso- vagal attack during a procedure and in 2 of these 14 circumstances IV atropine was used in response to a prolonged bradycardia. Only 5 clinicians had received training on how to respond to a vaso-vagal attack within the outpatient gynaecology clinic. All the responses differed one from the other.