Recovery position

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A form of the recovery position. Note that various forms of the recovery position are taught, and the position shown here differs from that described in the text, but the principles are similar. The mouth is downward so that vomit or blood can drain from the patient; the chin is well up to keep the epiglottis opened. Arms and legs are locked as to stabilise the position of the patient. Note that the female patient is safely on her left side (see "precautions").

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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).

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).

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.
A person with a chest injury should be turned onto the injured side. This is to 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.

External links

[NHS Direct - The recovery position]
[The Recovery Position] - step-by-step description with diagrams, from Harvard Medical School
[The Recovery Position] - step-by-step description with diagrams, from St. John Ambulance.

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