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.
The lecture Patient Positioning (Paramedic) by Justin Große Feldhaus is from the course Clinical Skills (Paramedic).
Which statements about patient positioning are true? Select all that apply.
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