- Positioning of unconscious patients with no suspected spinal injury to provide airway management.
- Patients in spinal considerations. Use the modified Lateral Trauma Position for these patients
- An unconscious patient, when left supine, is at risk of hypoxia and aspiration due to the relaxation of the airway structures and secretions obstructing the airway.
- The lateral or recovery position allows for drainage of any secretions and assists to maintain the patient's airway.
- Ensure usage of all relevant PPE.
- Pregnant females should be placed in the Left Lateral Tilt (LLT) for basic airway management. If patient in cardiac arrest, use Relief of Aortocaval Compression.
- The modified Trauma Lateral Position is for patients in spinal immobilisation whose airway cannot be managed with BLS/ALS intervention as a last resort
Key Principles
- The patient should be in as near a true lateral position as possible to allow free drainage of fluid and avoid airway obstruction.
- The position should be stable.
- Avoid any pressure on the patient's chest that impairs breathing.
- It should be possible to turn the patient onto their side and return to supine easily and safely, ensuring all consideration is given to the possibility of cervical spine injury.
- The position should allow good observation of and easy access to the patient's airway.
- The position itself should not cause any injury of the patient.
Procedure
- Kneel beside the patient, remove any spectacles and watches and check pockets for bulky items.[1]
- Place arm nearest to you at a right angle to the patient’s body with arm bent into the position it falls. Do not force arm into position.[2]
- Bring the arm furthest away from you across the patient’s chest and hold the back of the hand against their nearest cheek.[3]
- With your other hand, grasp the leg furthest from you just above the knee and pull it up keeping the foot on the ground.[4]
- Keep the patient’s hand pressed against the cheek and pull on the raised leg to roll the patient towards you onto their side.[5]
- Roll the patient gently towards you keeping your knees clear from their body and constantly supporting the head.[6]
- Adjust the patient’s upper leg so that both the hip and knee are bent at right angles. Adjust the patient’s hand under their cheek.[7]
- The patient is now in the lateral position, allowing airway to be maintained and secretions to drain.
- The patient is adequately conscious and alert to maintain own airway
- The patient's airway is no longer able to be maintained safely by the lateral position
- The patient requires additional airway management not able to be achieved in the lateral position
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Bartle, C; Levitan, R (January 2010). "Airway Establishment and Control". Merck Online Manuals: Critical Care Medicine.
Couper K, Abu Hassan A, Ohri V, et al. Removal of foreign body airway obstruction: A systematic review of interventions. Resuscitation 2020;156:174-81.
Douma MJ, Handley AJ, MacKenzie E, Raitt J, Orkin A, Berry D, Bendall J, O'Dochartaigh D, Picard C, Carlson JN, Djärv T, Zideman DA, Singletary EM. The recovery position for maintenance of adequate ventilation and the prevention of cardiac arrest: A systematic review. Resusc Plus. 2022 Apr 29;10:100236.
Hood N, Considine J. Spinal immobilisaton in pre-hospital and emergency care: a systematic review of the literature. Australasian Emergency Nursing Journal 2015;18:118-37.
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