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first aid First aid is the first and immediate assistance given to any person with a medical emergency, with care provided to preserve life, prevent the condition from worsening, or to promote recovery until medical services arrive. First aid is gener ...
, the recovery position (also called semi-prone) is one of a series of variations on a lateral recumbent or three-quarters prone position of the body, often used for unconscious but breathing casualties. An unconscious person, a person who is assessed on the Glasgow Coma Scale (GCS) at eight or below, in a
supine position The supine position () means lying horizontally, with the face and torso facing up, as opposed to the prone position, which is face down. When used in surgical procedures, it grants access to the peritoneal, thoracic, and pericardium, pericardial ...
(on the back) may not be able to maintain an open airway as a conscious person would. This can lead to an obstruction of the airway, restricting the flow of air and preventing gaseous exchange, which then causes hypoxia, which is life-threatening. Thousands of fatalities occur every year in casualties where the cause of unconsciousness was not fatal, but where airway obstruction caused the patient to suffocate. This is especially true for unconscious pregnant women; once turned on to their left side, pressure is relieved on the
inferior vena cava The inferior vena cava is a large vein that carries the deoxygenated blood from the lower and middle body into the right atrium of the heart. It is formed by the joining of the right and the left common iliac veins, usually at the level of the ...
, and venous return is not restricted. The cause of unconsciousness can be any reason from trauma to intoxication from alcohol. It is not necessarily used by health care professionals in an institutional setting, as they may have access to more advanced airway management techniques, such as
tracheal intubation Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic catheter, tube into the vertebrate trachea, trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer c ...
.


Purpose

The recovery position is designed to prevent suffocation through obstruction of the airway, which can occur in unconscious
supine In grammar, a supine is a form of verbal noun used in some languages. The term is most often used for Latin, where it is one of the four principal parts of a verb. The word refers to a position of lying on one's back (as opposed to ' prone', l ...
patients. The supine patient is at risk of airway obstruction from two routes: *Mechanical obstruction: In this instance, a physical object obstructs the airway of the patient. In most cases this is the patient's own tongue, as the unconsciousness leads to a loss of control and
muscle tone In physiology, medicine, and anatomy, muscle tone (residual muscle tension or tonus) is the continuous and passive partial contraction of the muscles, or the muscle's resistance to passive stretch during resting state.O’Sullivan, S. B. (2007) ...
, causing the tongue to fall to the back of the
pharynx The pharynx (: pharynges) is the part of the throat behind the human mouth, mouth and nasal cavity, and above the esophagus and trachea (the tubes going down to the stomach and the lungs respectively). It is found in vertebrates and invertebrates ...
, creating an obstruction. This can be controlled (to an extent) by a trained person using
airway management Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve an airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either ...
techniques. *Fluid obstruction: Fluids, usually vomit, can collect in the pharynx, effectively causing the person to drown. The loss of muscular control which causes the tongue to block the throat can also lead to the stomach contents flowing into the throat, called ''passive regurgitation''. Fluid which collects in the back of the throat can also flow down into the lungs. Another complication can be
stomach acid Gastric acid or stomach acid is the acidic component – hydrochloric acid – of gastric juice, produced by parietal cells in the gastric glands of the stomach lining. In humans, the pH is between one and three, much lower than most other an ...
burning the inner lining of the lungs, causing
aspiration pneumonia Aspiration pneumonia is a type of lung infection that is due to a relatively large amount of material from the stomach or mouth entering the lungs. Signs and symptoms often include fever and cough of relatively rapid onset. Complications may incl ...
. Placing a patient in the recovery position gives gravity assistance to the clearance of physical obstruction of the airway by the tongue, and also gives a clear route by which fluid can drain from the airway. The International Liaison Committee on Resuscitation (ILCOR) does not recommend one specific recovery position, but advises on six key principles to be followed: #The casualty should be in as near a true lateral position as possible with the head dependent to allow free drainage of fluid. #The position should be stable. #Any pressure of the chest that impairs breathing should be avoided. #It should be possible to turn the victim onto the side and return to the back easily and safely, having particular regard to the possibility of cervical spine injury. #Good observation of and access to the airway should be possible. #The position itself should not give rise to any injury to the casualty.


History

The earliest recognition that placing unconscious patients on their side would prevent obstruction of the airway was by Robert Bowles, a doctor at the Victoria Hospital in
Folkestone Folkestone ( ) is a coastal town on the English Channel, in Kent, south-east England. The town lies on the southern edge of the North Downs at a valley between two cliffs. It was an important harbour, shipping port, and fashionable coastal res ...
, England. In 1891 he presented a paper with the title '''On Stertor, Apoplexy, and the Management of the Apoplectic State''' in relation to
stroke Stroke is a medical condition in which poor cerebral circulation, blood flow to a part of the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemor ...
patients with noisy breathing from airway obstruction (also known as stertor). This paper was taken up by anaesthetist Frederick Hewitt from the
London Hospital The Royal London Hospital is a large teaching hospital in Whitechapel in the London Borough of Tower Hamlets. It is part of Barts Health NHS Trust. It provides district general hospital services for the City of London and London Borough of Tow ...
who advised a sideways position for postoperative patients. This thinking was, however, not widely adopted, with surgical textbooks 50 years later still recommending leaving anaesthetised patients in a supine position.
First aid First aid is the first and immediate assistance given to any person with a medical emergency, with care provided to preserve life, prevent the condition from worsening, or to promote recovery until medical services arrive. First aid is gener ...
organisations were similarly slow in adopting the idea of the recovery position, with 1930s and 1940s first aid manuals from the
British Red Cross The British Red Cross Society () is the United Kingdom body of the worldwide neutral and impartial humanitarian network the International Red Cross and Red Crescent Movement. The society was formed in 1870, and is a registered charity with 1 ...
and
St John Ambulance St John Ambulance is an affiliated movement of charitable organisations in mostly Commonwealth of Nations, Commonwealth countries which provide first aid education and consumables and emergency medical services. St John organisations are primari ...
both recommending lying a patient on their back. The 1938 British Red Cross First Aid Manual goes so far as to instruct "place the head in a such as position that the windpipe is kept straight, keeping the head up if the face is flushed, and in line with the body if it is pale". By contrast, the St. John manual advocated turning the head to the side, but it was not until the 1950 40th edition of the St. John Manual that it was added "if breathing is noisy (bubbling through secretions), turn the patient into the three-quarters prone position", which is very similar to a modern recovery position. A large number of positions were experimented with, mostly in Europe, as the United States did not widely take up the recovery position until its adoption by the
American Heart Association The American Heart Association (AHA) is a nonprofit organization in the United States that funds cardiovascular medical research, educates consumers on healthy living and fosters appropriate Heart, cardiac care in an effort to reduce disability ...
in 1992. Positions included the "Coma Position", " Rautek's Position" and the "HAINES (High Arm IN Endangered Spine) position". In 1992, the European Resuscitation Council adopted a new position where the arm nearest the floor was brought out in front of the patient, whereas it had previously been placed behind the patient. This change was made due to several reported cases of nerve and blood vessel damage in the arms of patients. ILCOR made its recommendations on the basic principles for recovery positions in 1996, but does not prescribe a specific position, and consequently, there are several in use around the world.


See also

* * *


References


External links


NHS Direct – The recovery position
(includes a video)
The Recovery Position
– step-by-step description with diagrams, from Harvard Medical School {{DEFAULTSORT:Recovery Position Emergency medicine First aid Human positions