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Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
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A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
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Shoulder Dystocia: Managing an Obstetric Emergency.

D Ashley Hill1, Jorge Lense2, Fay Roepcke3

  • 1AdventHealth Graduate Medical Education Program, Orlando, FL, USA.

American Family Physician
|July 16, 2020
PubMed
Summary

Shoulder dystocia is a serious birth emergency requiring immediate intervention. Prompt recognition and management, including specific maneuvers and team training, are crucial for successful delivery and preventing neonatal and maternal complications.

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Area of Science:

  • Obstetrics
  • Neonatal Medicine
  • Emergency Medicine

Background:

  • Shoulder dystocia is an obstetric emergency where shoulder delivery is impeded after fetal head emergence.
  • It poses significant risks including neonatal brachial plexus injuries, hypoxia, and maternal trauma, such as bladder, anal sphincter, and rectal damage, and postpartum hemorrhage.
  • While risk factors like fetal macrosomia and diabetes exist, many cases are unpredictable.

Purpose of the Study:

  • To outline the critical steps and maneuvers for managing shoulder dystocia.
  • To emphasize the importance of preparedness, training, and simulation for labor and delivery teams.
  • To detail various release maneuvers and advanced interventions for shoulder dystocia resolution.

Main Methods:

  • Review of established obstetric emergency protocols for shoulder dystocia.
  • Description of recommended communication and time-keeping strategies during delivery.
  • Explanation of maneuvers including McRoberts, suprapubic pressure, and internal rotation.
  • Discussion of advanced techniques like clavicular fracture and cephalic replacement.
  • Emphasis on institutional preparedness for surgical intervention (abdominal rescue).

Main Results:

  • Effective management relies on immediate recognition and clear communication.
  • Standard maneuvers (McRoberts, suprapubic pressure, etc.) are successful in most cases.
  • Advanced maneuvers and surgical intervention may be necessary when initial methods fail.
  • Simulation exercises enhance team performance in managing this emergency.

Conclusions:

  • Shoulder dystocia demands a prepared and coordinated team response.
  • Calm and systematic application of release maneuvers is key to successful delivery.
  • Institutions must simulate and prepare for all potential management scenarios, including surgical rescue.