Recovery position

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Image:Recovery position.jpg The recovery position is a first aid technique recommended for assisting people who are unconscious, or nearly so, but are still breathing. It is frequently taught as part of classes in CPR (cardiopulmonary resuscitation).

1 Purpose
2 Precautions
3 Modus Operandi
4 External links

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Purpose

The main aim of the recovery position is to protect the airway of an unconscious person, so that the person can breathe.

When an unconscious person is lying face upwards, there are two main risks factors which can lead to suffocation:

The tongue can fall to the back of the throat, due to loss of muscular control. The back of the tongue then obstructs the airway.

Fluids, possibly blood but particularly vomit, can collect in the back of the throat, causing the person to drown. When a person is lying face up, the oesophagus tilts down slightly from the stomach towards the throat. This, combined with loss of muscular control, can lead to the stomach contents flowing into the throat, called passive regurgitation. As well as obstructing the airway, fluid which collects in the back of the throat can also then flow down into the lungs; stomach acid can attack the inner lining of the lungs and cause a condition known as aspiration pneumonia.

Many fatalities occur where the original injury or illness which caused unconsciousness is not itself inherently fatal, but where the unconscious person suffocates for one of these reasons. This is a common cause of death following unconsciousness due to excessive consumption of alcohol, which is by itself rarely poisonous enough to kill someone on its own.

It is possible to protect to some extent against risks to the airway from the tongue by tilting the head back and lifting the jaw. However, an unconscious person will not remain in this position unless held constantly, and crucially it does not safeguard against risks due to fluids. If the person is placed in the recovery position, the action of gravity will both keep the tongue from obstructing the airway and also allow any fluids to drain. Also the chest is raised above the ground, which also helps to make breathing easier.

The recovery position is also recommended for victims of drowning, and also for victims of suspected poisoning (who are liable to become unconscious).

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Precautions

Do not put a conscious patient who has fallen on his back into recovery position if he or she is not choking. This does no good and might worsen possible injuries to the spine.
If there is conflict between keeping the integrity of the spine and putting an unconscious patient in recovery position, the recovery position has priority. Better to have a living patient with a severed spine than a dead one with an intact spine.

Should the need arise to put a patient with suspected spinal injuries in recovery position, it is possible to minimise the risk by gathering at least three people who will position themselves all along the patient, crossing their hands to better feel what their neighbour is doing. The leader will secure the head and direct the operation.

A person with a chest injury should be turned onto the injured side. This is ensure that any blood within the chest cavity is more likely to affect only one lung rather than both of them, and if one lung is injured then the good lung is positioned off the ground making it easier to breathe.
Pregnant women : always put an unconscious pregnant woman in recovery position on her left side. This prevents compression of the Inferior vena cava by the uterus, which could be fatal for both the mother and the child.
It is possible to compress bloody injuries by putting the patient in recovery position on the bleeding side. A bleeding pregnant woman must be put on her left side no matter what.
Before turning a person, ensure that the ground beside them is free from objects which can cause injury. Also, remove hard or bulky objects from pockets on the near side (which the person would end up lying on), as these can cause pressure sores which can take many months to heal.

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Modus Operandi

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Image:Recovery position maneuver.jpg

The following steps describe how to put someone in the recovery position. However most first aid organisations strongly recommend learning by means of practical instruction. Note that even if the exact steps are not remembered, it is still generally much better to turn an unconscious person onto their side than to leave them on their back.

Put yourself in a position where you will be pulling the person toward you. Your own body can serve as a brake if the person's weight is more than you can control as you turn them.
Place the arm closest to you with right angles at both the shoulder and the elbow, in a "hand up" position. (Depending on the person, the back of the hand may touch the ground or it may not. If not, do not force it down.)
Raise the knee of the far leg. The foot of the far leg should end up flat on the ground, approximately next to the knee of the near leg.
Bring the hand of the far arm against the person's near cheek (palm outwards) and support it with your hand.
Turn the person onto the side by gently pulling the raised knee / thigh of the far leg, while continuing to hold the person's hand against their cheek with your other hand, thereby supporting the head. (Pulling the leg gives a lot of mechanical advantage, so with most patients you should not need to use a lot of force.)
When you have the person on their side, tilt the head back to ensure an open airway, adjusting the position of the arms as necessary to support the head in this position. Check the person's breathing.
For maximum stability, position the upper leg so that there are right angle bends at both the hip and the knee.

Note that if the person is so unconscious that the recovery position is necessary, it is also usually necessary that an ambulance or other medical personnel be called to the scene. Breathing should be monitored closely. In the event that breathing stops, the head position should be checked and the airway cleared. If this does not immediately restart breathing, then rescue breaths should be started immediately, and if no signs of circulation are present then full CPR should be started; this will require turning the person back onto their back.

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