Recovery Position Which Side?

[cayman diver]

Hi I recently did the new (30 compressions to 2 Breaths) Emergency First Response Course.

In the course they don't seem to say a side for the recovery position, have also looked on the internet (16 billion facts and all wrong) I found old guidelines saying the left side and current ones not mentioning a side (except for pregnant woman who should always lie on the left http://www.answers.com/topic/recovery-position) the UK Resuscitation Council also don't have a preferred side.

Does it now not matter which side you put them on (I know standards do change), Finally before anyone says it, I know if they are bleeding or serious bruising that side should go down, so blood doesn't collect on both lungs.
thanks

 

[Jez]

hey mate,

left side is preferred cause the stomach is on the left side so if the patient is on the right side the chances of them aspirating are higher. it's not going to be detriment if you put them on the right side as long as you monitor the airway closely.

hope that helps,

Jez

 

[tstormdiver]

I agree. In my EMT-FR course the same thing was taught.

 

[fisherdvm]

I don't know if I agree with the above. The fundus of the stomach is on the left side, but the pylorus is on the right side.

As a sufferer of gastroesophageal reflux, I can tell you my symptoms are aggravated by left recumbancy.

The gravity pulls the gastric fluid to the side you lay. If you are on right recumbancy, it drains into the pylorus and duedenum. If you are on left recumbancy, it makes it out the esophagus.

I'd suggest we poll the folks here with GERD and ask them which side they prefer to sleep on at night, my gut feeling is the right side.

 

[fisherdvm]

I guess I am wrong:

Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease
Ramez M. Khoury, M.D.a, Luciana Camacho-Lobato, M.D.a, Philip O. Katz, M.D.a, Muhammad A. Mohiuddin, M.D.a, and Donald O. Castell, M.D.a
OBJECTIVE: Body position has been shown to influence postprandial and fasting gastroesophageal reflux (GER) in patients and normal volunteers when they are assigned to lie in a prescribed position. No published studies have evaluated the effect of spontaneous sleeping positions on recumbent reflux in patients with GER.

METHODS: Ten patients, three female and seven male (mean age 47.6 yr, range 30&#8211;67 yr) with abnormal recumbent esophageal pH <4 on 24-h pH-metry participated. A standardized high fat dinner (6 PM) and a bedtime snack (10 PM) were administered to all patients. GER during spontaneous sleep positions was assessed with a single channel pH probe placed 5 cm above the lower esophageal sphincter (LES) and with a position sensor taped to the sternum. Data were recorded with a portable digital data logger (Microdigitrapper-S, Synectics Medical) and analyzed for recumbent percent time pH <4 and esophageal acid clearance time in each of four sleeping positions. Time elapsed between change in sleeping position and GER episodes was also calculated.

RESULTS: Right lateral decubitus was associated with greater percent time pH <4 (p< 0.003) and longer esophageal acid clearance (p< 0.05) compared to the left, supine, and prone. GER episodes were more frequent in the supine position (p< 0.04) and occurred within 1 min after change in sleeping position 28% of the time.

CONCLUSIONS: The left lateral decubitus position is preferred in patients with nocturnal GER. Measures to aid patients in sleeping in this position should be developed.

 

[OBXDIVEGUY]

they used to tach left to lay rescurer classes, but now things have been simplified. Less important details are left out, just as long as you remember to put them on their side, it will help.

The left is the preferred because of the way the airway branches out into the lungs. I can't remember the details, but it was something about one bronchi is higher than the other or something.

 

[fisherdvm]

Oh, yeh, I vaguely remember. I think one bronchi is larger than the other so it's less likely to be obstructed if you aspirated or something.

 

[knotical]

Several years ago, I too looked for an authoritative reference source with rationale for the left-side convention, with very little success. Finally I initiated an email correspondence with Dr. Jolie Bookspan, noted scuba physiologist. She provided an interesting insight. She said the left-hand convention probably originated many years ago when ambulances were converted hearses, and cramped. Presumably the provider did not want the patient facing away from them.

She also told of one of the old scuba theories:
Quote:
&#8220;It used to be thought that the head-down-left-side-lying (left lateral decubitus position) would cause bubbles to stay in the inferior vena cava, and by elevating the feet, would move the bubbles to the legs since they float up (the bubbles, not the feet). Too bad it didn&#8217;t work. Not even if you cut off the big toes to let the gas escape.&#8221;

Dr. Bookspan is a great de-bunker of myths, and her amusing way of teaching is one of the reasons I am such a fan. http://www.drbookspan.com/books.html

When I teach recovery position in first aid courses, I tell students that the side generally doesn&#8217;t matter, unless there is another indication, (such as placing stroke patients with their good side up). I may have to add pregnancy and GERD as possible considerations.

 

[Dive-aholic]

Left side is preferred...probably for the reason knotical points out. Laying on the left side allows the patient to be facing the paramedic in the ambulance. However, the anatomy does also play a factor. The reason we turn the patient to the side is to prevent aspiration should the patient vomit. If a patient is going to vomit, then it will happen. If the patient is on the left side, the contents of the stomach will have an easier route out of the stomach if on the left side.

As for the lungs. The left bronchus has more of an angle than the right side due to the heart being towards the left. I don't know that it makes a difference with aspiration.

Pregnant women do need to be on the left side, so simplifying it to all patients on left side just makes sense. It's a lot easier to remember than "i after e except after c and in the following words....." One way, no mistake.

 

[Fort Collins Bob]

After having being involved w/ some diving emergencies..

The recovery position works very well to allow the person
to breath better, as opposed to laying on their backs.

bob