why do we place the casualty in the recovery position

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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, England. In 1891 he presented a paper with the title \’On Stertor, Apoplexy, and the Management of the Apoplectic State\’
in relation to patients with noisy breathing from airway obstruction (also known as ). This paper was taken up by anaesthetist Frederick Hewitt from the 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. organisations were similarly slow in adopting the idea of the recovery position, with 1930s and 1940s first aid manuals from the and both recommending lying a patient on their back.

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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 in 1992.

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Positions included the \”Coma Position\”, \”Rautek\’s Position\” and the \”HAINES (High Arm IN Endangered Spine) position\”. In 1992, the 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.

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The recovery position is used to protect an unconscious person s airway. It involves rolling the casualty onto their side with the head tilted back but should it be the left or right side? This is a common question asked on first aid CPR courses by candidates. There are also lots of different explanations about which side is better. Before we consider this question, let s remind ourselves of how the recovery position works. The recovery position works by protecting the casualty s airway. An unconscious patient will be unable to protect their airway due to loss of muscle tone resulting in the tongue blocking the airway as shown in the diagram below. In addition, the recovery position protects against aspiration ( inhalation ) of stomach contents.

PBy placing the casualty on their side, any stomach contents will drain away from the airway. So which side is better? Short answer P it doesn t matter which side you roll a patient onto! Your main priority with the recovery position is toP save life andP maintain a patent airway. This is the absolute priority and should take precedent over other actions. Do not waste unnecessary time deciding which sideP might be better to roll them onto. There is one main exception to this rule. In an unconscious casualty who is heavily pregnant you should attempt to roll them onto theirP left side. This prevents the baby from compressing one of the main blood vessels in the abdomen.

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