رجل عمره ٦٨ سنة بعد قسطرة عبر الشريان الفخذي، والممرض ينزع الغمد بالضغط اليدوي. قبل النزع: الضغط ١٢٨/٧٦، النبض ٧٨. أثناء الضغط صار المريض شاحباً ومتعرقاً ويتثاءب، ونبضه نزل إلى ٤٤ وضغطه إلى ٨٠/٤٦. ما أول إجراء؟

A 68-year-old man post femoral catheterisation is having the sheath removed with manual pressure. Before removal BP 128/76, HR 78. During compression he becomes pale, sweaty and yawning; HR falls to 44 and BP to 80/46. What is the first action?

1. Raise the head of the bed to 45 degrees to ease breathing
2. Give nitroglycerin because the client may be ischaemic
3. Lower the head of the bed, keep pressure on the site and call for help
4. Release pressure on the site to reduce the vagal stimulus

Answer: C) Lower the head of the bed, keep pressure on the site and call for help. This is a common vasovagal response during sheath removal. Lay the client flat, keep pressure to prevent bleeding and call for help to give fluids and atropine as ordered. Releasing pressure causes bleeding, and nitroglycerin drops the pressure further.