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Patient Positioning (Paramedic)

by Justin Große Feldhaus

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    00:01 How do I position my patient correctly? In this lecture, I would like to introduce you to the different types of positioning and some basic positioning techniques.

    00:11 Knowing how to position a patient is a critical skill for all medical professionals.

    00:18 I can achieve a lot by simply changing the patient's position.

    00:22 I can help keep the airways clear, which makes breathing much easier. I can improve general perfusion, which is the blood flow to the main organs.

    00:35 The same applies, of course, to local tissue perfusion.

    00:38 I can also minimize bleeding, immobilize, and relieve pain.

    00:49 Which position I choose depends on the indication.

    00:55 This type of treatment should be done early and in a targeted manner, as it is such a basic measure.

    01:01 You must assess the patient to determine the indication to change their current position.

    01:06 Is the airway at risk? If the patient is in respiratory distress or showing symptoms of shock? They may present with low-blood pressure or an increased heart rate.

    01:18 In these cases, a change of position can help.

    01:23 If the patient complains of pain, has open wounds, or has suffered severe bleeding, repositioning can provide them some relief. The same applies if the patient's vessels are occluded.

    01:39 All these examples are possible indications.

    01:43 We must also understand that these same indications may exclude specific patient positioning. This is especially true in trauma cases. An example would be that in order to shift the patient, you need to move body parts that have not been examined.

    02:01 Doing so may cause or aggravate the patient's injuries.

    02:12 Therefore, please remember that all the factors mentioned as indications can also be contraindications for certain positioning techniques.

    02:21 In the following technique video, we will see the different types of positioning and discuss their indications again.

    02:30 The rescue service was called to a construction site with the complaint being a heavily bleeding wound.

    02:36 There, a middle-aged man is found to have severely injured his forearm while working with a saw, causing significant arterial bleeding.

    02:45 When the ambulance service arrives, the patient appears awake and oriented, but has already lost 200 to 300 milliliters of blood.

    02:54 As an initial measure, the two medics elevate the arm and compress the brachial artery. The wound is immediately dressed with a pressure dressing, adding additional wound compression.

    03:20 The injured extremity is then elevated.

    03:34 A short time later, it is noticed that the bandage is already saturated. The practitioners apply a second dressing over the first.

    03:52 The second dressing is then also saturated, so they choose to apply a tourniquet . The tourniquet is applied as distally as possible while still avoiding the wound.

    04:02 The general rule is that it should be applied at least five centimeters proximal from wound margin.

    04:10 Twisting the strap prevents blood flow to the extremity.

    04:15 Tipp: Before closing the white strip, pull the free end of the strap into the clips to secure this free end with the white strip as well.

    04:23 This avoids accidental friction/hooking to the strip, making it unbuckle, and the tourniquet could lose its tightness.

    04:31 The strap is then secured, and the time at which the tourniquet was applied is documented.

    04:43 While one provider starts the initial pain medication, the other one already initiates the transport of the patient to the hospital in parallel.

    04:52 Now let's move on to upper body positioning.

    04:57 In the second case, a young patient is found with severe acute respiratory distress.

    05:03 The provider first lifts the headboard of the bed, raising the patient's torso. This improves breathing by improving lung inflation and allowing the patient to utilize their accessory respiratory musculature effectively.

    05:21 If you have identified a cardiac cause, the upper body should not be elevated beyond 30 degrees.

    05:28 The provider then begins further diagnostic and therapeutic measures.

    05:34 Now let us discuss the shock position in a clinical scenario.

    05:39 In a patient with low blood pressure, the shock physician can be a good initial treatment. Low blood pressure can be caused by hypovolemia, stemming from severe bloodloss, or maldistribution of body's fluid volume . For shock positioning, the upper body is positioned flat and the legs are elevated to about 30 degrees.

    06:06 This improves the venous return of blood to the heart and thus increases the overall cardiac output.

    06:16 Immediately after this measure, further diagnostics and treatments are usually required. We can now look at another variation of the shock position, this time in a prehospital scenario. Here, the shock position is mildly different.

    06:35 In this case, the rescue service was called for a person that collapsed.

    06:39 Upon arrival, the providers find an alert, oriented young woman being cared for by a first responder.

    06:46 The peripheral pulse is difficult to palpate.

    06:49 She is cold, sweaty and indicates dizziness.

    06:59 The blood pressure is found to be below the normal value, indicating the patient is hypotonic. The first therapeutic measure is now shock management.

    07:13 If hypotension is caused by volume deficiency or volume maldistribution, shock positioning can be a good basic care tool as it raises blood pressure for a small period of time.

    07:25 To do this, the practitioner positions the legs upwards by about 30 degrees.

    07:30 This can be done with the help of a chair, r esulting in significantly improved venous return and overall cardiac output.

    07:43 For a short time, hypotension can be successfully treated with this basic measure. Afterwards, further therapeutic and diagnostic measures are of course indicated.

    07:57 The last thing we will look at is the recovery position.

    08:00 If you encounter an unconscious patient that still has adequate respiration, the recovery position is a good means of securing their airway.

    08:12 It can be performed quickly and easily.

    08:15 The practitioner positions the patient on their side, thus keeping the airway clear and allowing vomit to drain without the risk of aspiration.

    08:28 Remember, the prerequisite for this maneuver is that the patient has a sufficiently high respiratory frequency and volume.

    08:39 After the patient has been placed in this position, their vital signs are checked closely, especially their respiratory rate.

    08:48 Further therapeutic and diagnostic measures then may follow accordingly.


    About the Lecture

    The lecture Patient Positioning (Paramedic) by Justin Große Feldhaus is from the course Clinical Skills (Paramedic).


    Included Quiz Questions

    1. The shock position can briefly increase the output of the heart and raise blood pressure.
    2. The stable lateral (recovery) position places a patient on their side with the head hyperextended and the mouth below the stomach.
    3. Upper body positioning does not impact a patient's breathing.
    4. The first choice to stop bleeding is the tourniquet.
    5. A tourniquet should be applied as proximal to the affected extremity as possible.

    Author of lecture Patient Positioning (Paramedic)

     Justin Große Feldhaus

    Justin Große Feldhaus


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