Tag: shoulder dystocia

Shoulder dystocia

Shoulder dystocia is a relatively uncommon obstetric emergency. Despite this, care providers, particularly at Sunshine Hospital, must still be aware of the steps to take to address dystocia in the event obstetric support is unavailable.

Shoulder Dystocia guideline (WH – last review 2013)


Watch a short video filmed by Dr Neil Long FACEM, in collaboration with the midwifery education team of Sunshine hospital (5min)



Mechanically, shoulder dystocia occurs due to a mismatch between the antero-posterior width of the baby’s shoulders relative to the mother’s pelvis, causing obstructed labour. All techniques seek to manipulate these dimensions and correct this mismatch.

Key points:

  1. call for help early (obstetric as a given but remember paediatric/neonatal support and anaesthetic support)
  2. manipulate (widen) pelvis: McRoberts position (hips flexed)
  3. manipulate (relatively reduce) shoulders: suprapubic pressure / shoulder rotation / deliver arms
  4. consider episiotomy
  5. try on all fours position if safe
  6. consider salvage manuevers


Additional resources

watch: longer video also describing salvage techniques (10min)


watch: a dramatisation, solely to stimulate your adrenaline response (4min)


Simulation Olympics 2016

UPDATED 9/3/17 – See Dr Neil Long’s additional notes regarding the stations below

On the 14th December ED Consultant Dr David Alexander and simulation registrar Dr Neil Long staged the annual simulation olympics with this year’s event  – “the Pentathlon” – featuring resuscitation stations such as “the swimmer”, “the runner”, “the fencer”, “the shooter” and “the rider”.

Congratulations to registrars Gordon Carter and Mark Daley representing “the Republic of Ireland” who stormed home for the gold medal.


Thanks to all the registrars who came and participated.

[L-R: Sze-Chi + Jess, Son + Kiri, Sheri + Jamie, Rob + Annie, Emily + Maddy, Heather + Ben]

Thanks to Dr Luigi Marino, Dr Raj Patel, Dr Sam Robertson and the simulation centre staff for their help running the morning.




Wolff-Parkinson-White Syndrome with Atrial Fibrillation

• Very rapid irregularly irregular tachycardia (rates may approach 300 beats/min) with wide QRS complexes that vary in morphology
• Often misdiagnosed as SVT, VT or atrial fibrillation with BBB
• Misdiagnosis and treatment with AVN blockers can be deadly!
• Treat with procainamide, flecainide (?), or preferably electrical cardioversion
• Key Point: Avoid all AV Nodal blockers
• Adenosine
• Beta-blockers
• Calcium channel blockers
• Digoxin
• Amiodarone
Pitfall: Treatment with Amiodarone results in patient decompensation (see references)
Take Home Points:
WPW + Atrial Fibrillation
• Irregularly irregular tachycardia
• Complexes vary in shape and width
• May approach 250-300 bpm or higher
• Avoid all AV nodal blockers…including Amiodarone!
• Use Procainamide, Flecainide (?),or electrical cardioversion

Traumatic Cardiac Arrest Algorithm from the European Resuscitation Council

Main changes:
  1. don’t do CPR
  2. control catastrophic haemorrhage
  3. control the airway
  4. bilateral chest decompressions
  5. relieve cardiac tamponade
  6. consider prox aortic compression
  7. MTP
  8. CPR can commence once the chest procedures have been completed but in the context of trauma and hemorrhagic loss your CPR will be useless if you don’t correct the underlying cause.

Heat Stroke

Heat Stroke


Shoulder dystocia

Video coming soon