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<title>Recovery position</title>

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<span id="openzim-page-title" class="mw-page-title-main"><span class="mw-page-title-main">Recovery position</span></span>

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</style><table class="infobox"><tbody><tr><th colspan="2" class="infobox-above" style="background-color: lightblue">Recovery position</th></tr><tr><td colspan="2" class="infobox-image"><div class="infobox-caption">All forms of the recovery position share basic principles. The mouth is downward so that fluid can drain from the patient's airway; the chin is well away from the throat to keep the <a href="Epiglottis" title="Epiglottis">epiglottis</a> opened. Arms and legs are nested to stabilize the position of the patient</div></td></tr></tbody></table>

<p>In <a href="First_aid" title="First aid">first aid</a>, the <b>recovery position</b> (also called <b>semi-prone</b>) is one of a series of variations on a lateral recumbent or three-quarters <a href="Prone_position" title="Prone position">prone</a> position of the body, often used for <a href="Unconsciousness" title="Unconsciousness">unconscious</a> but breathing casualties.

</p><p>An unconscious person, a person who is assessed on the <a href="Glasgow_Coma_Scale" title="Glasgow Coma Scale">Glasgow Coma Scale (GCS)</a> at eight or below, in a <a href="Supine_position" title="Supine position">supine position</a> (on the back) may not be able to <a href="Airway_management" title="Airway management">maintain an open airway</a> as a conscious person would.<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> This can lead to an obstruction of the airway, restricting the flow of air and preventing gaseous exchange, which then causes <a href="Hypoxia_(medical)" class="mw-redirect" title="Hypoxia (medical)">hypoxia</a>, 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.<sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> This is especially true for unconscious pregnant women; once turned on to their left side, pressure is relieved on the <a href="Inferior_vena_cava" title="Inferior vena cava">inferior vena cava</a>, and venous return is not restricted. The cause of unconsciousness can be any reason from <a href="Physical_trauma" class="mw-redirect" title="Physical trauma">trauma</a> to <a href="Alcohol_intoxication" title="Alcohol intoxication">intoxication from alcohol</a>.

</p><p>It is not necessarily used by health care professionals in an institutional setting, as they may have access to more <a href="Advanced_airway_management" title="Advanced airway management">advanced airway management techniques</a>, such as <a href="Tracheal_intubation" title="Tracheal intubation">tracheal intubation</a>.

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<div class="mw-heading mw-heading2"><h2 id="Purpose">Purpose</h2></div>

<p>The recovery position is designed to prevent suffocation through obstruction of the airway, which can occur in unconscious <a href="Supine_position" title="Supine position">supine</a> patients. The supine patient is at risk of airway obstruction from two routes:

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<ul><li><b>Mechanical obstruction</b>: 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 <a href="Muscle_tone" title="Muscle tone">muscle tone</a>, causing the tongue to fall to the back of the <a href="Pharynx" title="Pharynx">pharynx</a>, creating an obstruction. This can be controlled (to an extent) by a trained person using <a href="Airway_management" title="Airway management">airway management</a> techniques.</li>

<li><b>Fluid obstruction</b>: 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 <i>passive regurgitation</i>. Fluid which collects in the back of the throat can also flow down into the lungs. Another complication can be <a href="Stomach_acid" class="mw-redirect" title="Stomach acid">stomach acid</a> burning the inner lining of the lungs, causing <a href="Aspiration_pneumonia" title="Aspiration pneumonia">aspiration pneumonia</a>.</li></ul>

<p>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.

</p><p>The <a href="International_Liaison_Committee_on_Resuscitation" title="International Liaison Committee on Resuscitation">International Liaison Committee on Resuscitation</a> (ILCOR) does not recommend one specific recovery position, but advises on six key principles to be followed:<sup id="cite_ref-aha_4-0" class="reference"><a href="#cite_note-aha-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup>

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<ol><li>The casualty should be in as near a true lateral position as possible with the head dependent to allow free drainage of fluid.</li>

<li>The position should be stable.</li>

<li>Any pressure of the chest that impairs breathing should be avoided.</li>

<li>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.</li>

<li>Good observation of and access to the airway should be possible.</li>

<li>The position itself should not give rise to any injury to the casualty.</li></ol>

<div class="mw-heading mw-heading2"><h2 id="History">History</h2></div>

<p>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 <a href="Folkestone" title="Folkestone">Folkestone</a>, England.<sup id="cite_ref-aha_4-1" class="reference"><a href="#cite_note-aha-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> In 1891 he presented a paper with the title <i>'On Stertor, Apoplexy, and the Management of the Apoplectic State'</i> in relation to <a href="Stroke" title="Stroke">stroke</a> patients with noisy breathing from airway obstruction (also known as <a href="Stertor" title="Stertor">stertor</a>).

</p><p>This paper was taken up by anaesthetist Frederick Hewitt from the <a href="Royal_London_Hospital" title="Royal London Hospital">London Hospital</a> 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.<sup id="cite_ref-aha_4-2" class="reference"><a href="#cite_note-aha-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup>

</p><p><a href="First_aid" title="First aid">First aid</a> organisations were similarly slow in adopting the idea of the recovery position, with 1930s and 1940s first aid manuals from the <a href="British_Red_Cross" title="British Red Cross">British Red Cross</a> and <a href="St_John_Ambulance" title="St John Ambulance">St John Ambulance</a> 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".<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> 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",<sup id="cite_ref-aha_4-3" class="reference"><a href="#cite_note-aha-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> which is very similar to a modern recovery position.

</p><p>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 <a href="American_Heart_Association" title="American Heart Association">American Heart Association</a> in 1992.<sup id="cite_ref-aha_4-4" class="reference"><a href="#cite_note-aha-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Positions included the "Coma Position", "<a href="Franz_Rautek" title="Franz Rautek">Rautek's Position</a>" and the "HAINES (High Arm IN Endangered Spine) position".

</p><p>In 1992, the <a href="European_Resuscitation_Council" title="European Resuscitation Council">European Resuscitation Council</a> 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.

</p><p>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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<ul><li><a href="Basic_airway_management" title="Basic airway management">Basic airway management</a></li>

<li><a href="Basic_life_support" title="Basic life support">Basic life support</a> – Emergency medical care by first responder</li>

<li><a href="Human_positions" class="mw-redirect" title="Human positions">Human positions</a> – Physical configurations of the human body<span style="display:none" class="category-annotation-with-redirected-description">Pages displaying short descriptions of redirect targets</span></li></ul>

<div class="mw-heading mw-heading2"><h2 id="References">References</h2></div>

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</style><cite id="CITEREFBartle,_CLevitan,_R2010" class="citation web cs1">Bartle, C; Levitan, R (January 2010). <a rel="nofollow" class="external text" href="http://www.merck.com/mmpe/sec06/ch066/ch066b.html">"Airway Establishment and Control"</a>. Merck Online Manuals: Critical Care Medicine.</cite></span>

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<li id="cite_note-2"><span class="mw-cite-backlink"><b><a href="#cite_ref-2">^</a></b></span> <span class="reference-text"><cite class="citation news cs1"><a rel="nofollow" class="external text" href="http://news.bbc.co.uk/1/hi/health/8612194.stm">"First aid 'could save thousands'"</a>. BBC News. 2010-04-12.</cite></span>

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<li id="cite_note-3"><span class="mw-cite-backlink"><b><a href="#cite_ref-3">^</a></b></span> <span class="reference-text"><cite class="citation news cs1"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20100417224103/http://www.gm.tv/lifestyle/health/save-a-life/47641-be-the-difference.html">"Be the difference"</a>. GMTV. 2010-04-11. Archived from <a rel="nofollow" class="external text" href="http://www.gm.tv/lifestyle/health/save-a-life/47641-be-the-difference.html">the original</a> on 2010-04-17.</cite></span>

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<li id="cite_note-aha-4"><span class="mw-cite-backlink">^ <a href="#cite_ref-aha_4-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-aha_4-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-aha_4-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-aha_4-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-aha_4-4"><sup><i><b>e</b></i></sup></a></span> <span class="reference-text"><cite id="CITEREFHandley2001" class="citation journal cs1">Handley, Anthony J (2001). <a rel="nofollow" class="external text" href="http://www.americanheart.org/downloadable/heart/1054148696790fall2001.pdf">"A brief history: The Recovery Position"</a> <span class="cs1-format">(PDF)</span>. <i>Currents in Emergency Cardiovascular Care</i>. <b>12</b> (3). American Heart Association.</cite></span>

</li>

<li id="cite_note-5"><span class="mw-cite-backlink"><b><a href="#cite_ref-5">^</a></b></span> <span class="reference-text"><cite id="CITEREFSt._J.D._Buxton1938" class="citation book cs1">St. J.D. Buxton (1938). <i>British Red Cross Society First Aid Manual No. 1</i> (Eight ed.). Cassell and Company Ltd.</cite></span>

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<div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2></div>

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<div class="side-box-text plainlist">The Wikibook <i><a href="https://en.wikibooks.org/wiki/First_Aid" class="extiw external" title="wikibooks:First Aid">First Aid</a></i> has a page on the topic of: <i><b><a href="https://en.wikibooks.org/wiki/First_Aid/Primary_Assessment_%26_Basic_Life_Support" class="extiw external" title="wikibooks:First Aid/Primary Assessment & Basic Life Support">Primary Assessment & Basic Life Support</a></b></i></div></div>

</div>

<div class="side-box-text plainlist">Wikimedia Commons has media related to <a href="https://commons.wikimedia.org/wiki/Recovery_position" class="extiw external" title="commons:Recovery position"><span style="font-style:italic; font-weight:bold;">Recovery position</span></a>.</div></div>

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<ul><li><a rel="nofollow" class="external text" href="http://www.nhs.uk/conditions/accidents-and-first-aid/pages/the-recovery-position.aspx">NHS Direct – The recovery position</a> (includes a video)</li>

<li><a rel="nofollow" class="external text" href="https://www.health.harvard.edu/staying-healthy/emergencies-and-first-aid-recovery-position">The Recovery Position</a> – step-by-step description with diagrams, from Harvard Medical School</li></ul>

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</style><div id="First_aid61" style="font-size:114%;margin:0 4em"><a href="First_aid" title="First aid">First aid</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Techniques</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Abdominal_thrusts" title="Abdominal thrusts">Abdominal thrusts</a></li>

<li><a href="Airway_management" title="Airway management">Airway management</a>

<ul><li><a href="Basic_airway_management" title="Basic airway management">Basic</a></li>

<li><a href="Advanced_airway_management" title="Advanced airway management">Advanced</a></li></ul></li>

<li><a href="Cardiopulmonary_resuscitation" title="Cardiopulmonary resuscitation">Cardiopulmonary resuscitation</a></li>

<li><a href="Emergency_bleeding_control" title="Emergency bleeding control">Emergency bleeding control</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Equipment</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Automated_external_defibrillator" title="Automated external defibrillator">Automated external defibrillator</a></li>

<li><a href="Bag_valve_mask" title="Bag valve mask">Bag valve mask</a></li>

<li><a href="Bandage" title="Bandage">Bandage</a></li>

<li><a href="Dressing_(medicine)" title="Dressing (medicine)">Dressing</a></li>

<li><a href="First_aid_kit" title="First aid kit">First aid kit</a></li>

<li><a href="Nasopharyngeal_airway" title="Nasopharyngeal airway">Nasopharyngeal airway</a></li>

<li><a href="Oropharyngeal_airway" title="Oropharyngeal airway">Oropharyngeal airway</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Mnemonics</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">

<li><a href="OPQRST" title="OPQRST">OPQRST</a></li>

<li><a href="SAMPLE_history" title="SAMPLE history">SAMPLE</a></li>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Certifications</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Certified_first_responder" title="Certified first responder">Certified first responder</a></li>

<li><a href="Emergency_medical_technician" title="Emergency medical technician">Emergency medical technician</a></li>

<li><a href="Wilderness_emergency_medical_technician" title="Wilderness emergency medical technician">Wilderness emergency medical technician</a></li></ul>

</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Topics</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em">

<ul><li><a href="Bleeding" title="Bleeding">Bleeding</a></li>

<li><a href="Golden_hour_(medicine)" title="Golden hour (medicine)">Golden hour</a></li>

<li><a href="Good_Samaritan_law" title="Good Samaritan law">Good Samaritan law</a></li>

<li><a href="Wilderness_first_aid" class="mw-redirect" title="Wilderness first aid">Wilderness medicine</a></li></ul>

</div></td></tr></tbody></table></div></div><div><div class="zim-footer">

This article is issued from <a class="external text" title="Last edited on 2025-02-15" href="https://en.wikipedia.org/wiki/?title=Recovery_position&oldid=1275784394">Wikipedia</a>. The text is available under <a class="external text" href="https://creativecommons.org/licenses/by-sa/4.0/deed.en">Creative Commons Attribution-Share Alike 4.0</a> unless otherwise noted. Additional terms may apply for the media files.

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