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First Aid: Questions about the Recovery Position Watch

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    If you suspect a spinal or head injury, do you still use the position if their airway is blocked? Is there another way to unblock the airway, without moving the casualty too much?

    Also if you suspect sharp objects like needles in pockets, do you remove them using gloves or something? Do you need a special bag?

    Thanks
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    I'm a newly trained first aider so I'd say take my advice with a pinch of salt. I wouldn't move a head/spinal injury at all. Only tilt head up if airway is blocked. Try and remove sharp objects with gloves but only if comfortable doing so. Otherwise your safety comes first. Sharps need to go into a sharps bin and if you don't have access to one give it to the paramedics.
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    (Original post by alleycat393)
    I'm a newly trained first aider so I'd say take my advice with a pinch of salt. I wouldn't move a head/spinal injury at all. Only tilt head up if airway is blocked. Try and remove sharp objects with gloves but only if comfortable doing so. Otherwise your safety comes first. Sharps need to go into a sharps bin and if you don't have access to one give it to the paramedics.
    I'd use a jaw thrust instead of a head tilt if you suspect a spinal injury.
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    You would want to limit movement as much as possible in a suspected spinal injury. The best option would be using maneuvers like a jaw thrust (more easily said than done in a semi-conscious patient) while maintaining a head neutral position.

    That said, maintaining an airway trumps all and needs to be made a priority.
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    You need to remember three things:

    1. use common sense, this isn't america and you aren't going to be sued for trying to help someone as long as you're sensible

    2. your own safety comes before anything else, creating a second casualty will not help the situation

    3. keeping the casualty alive (breathing) comes next

    so if you suspect there may be dangerous objects (and needles are definitely dangerous) you don't attempt to move them, it's better for the casualty not to be rolled onto needles but you don't risk your own life to remove them

    as far as moving a spinal injury, if you can avoid it then don't but if the casualty's airway is compromised (or, for example, you need to leave them to signal the ambulance and you are concerned they might stop breathing in that time) you have to move them to ensure they can breathe, at the end of the day it's the same as breaking ribs during chest compression - without breathing and a heart beat that person is DEAD, you can't make the situation worse at that point - you just ahve to do your best to keep them alive and then let the trained medics deal with everything else
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    Can't tell you a lot about civilian first aid but military procedure is to apply common sense albeit from a reservist so take it with a pinch of salt =P. The airway should be cleared by a chin tilt anyway, if its a liquid obstruction then you're better to use the recovery position or - if you have help - log roll them to clear it. With any spinal injury log rolls are the best principle. If its a gripping obstruction ie you cant clear it by tilting or reaching into their gob then recovery won't help anyway. There's no reason to recovery a spinal injury unless they have a catastrophic bleed or other more pressing issue. We have always been told jaw thrusts are a load of rubbish, if you need them its for biochem burns or extreme blockage like shrapnel (it does happen) but I dont know civilian guidance. A half tilt can be used, just open their mouth and check for obstructions - if there are none then all is good, if there are some then thats priority so do a full tilt. Again all common sense really.

    As for sharp objects remove them if you can but dont risk yourself. You dont need a special bag or anything just get them out of the way. We had someone get injured with a knife in their smock pocket whilst training and it just got lobbed into the grass so we could treat them. Be more cautious depending on the situation ie if its a drug addict who has collapsed make 100% sure not to stab yourself removing the syringe
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    (Original post by GonvilleBromhead)
    We have always been told jaw thrusts are a load of rubbish
    Who told you that?! They make a world of difference if done properly.
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    (Original post by Etomidate)
    Who told you that?! They make a world of difference if done properly.
    To elaborate we have been told they are a last resort and that their use can potentially endanger the person who they are used on as well as making them 'man down' ie we can't then put them back into the fight once they recover if the medic clears them which is specific to military considerations. There is not a lot of advantage in using thrusts unless its a stubborn obstruction at which point we wont be able to get them back in anyway so their safety takes priority. Its always the person first and foremost but we try and avoid them to prevent unnecessary casevacs. So rubbish from that perspective. Civvy first aid I have no idea, never done it.

    edit - Reason being soldiers are more likely to have problematic materials in their mouths ie shrapnel, phosphorous, other hazardous/reactive/sharp objects so pressing down like that may well kill them. This is why a half tilt is always used to check what the obstruction is before proceeding.
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    (Original post by GonvilleBromhead)
    To elaborate we have been told they are a last resort and that their use can potentially endanger the person who they are used on as well as making them 'man down' ie we can't then put them back into the fight once they recover if the medic clears them which is specific to military considerations. There is not a lot of advantage in using thrusts unless its a stubborn obstruction at which point we wont be able to get them back in anyway so their safety takes priority. Its always the person first and foremost but we try and avoid them to prevent unnecessary casevacs. So rubbish from that perspective. Civvy first aid I have no idea, never done it.

    edit - Reason being soldiers are more likely to have problematic materials in their mouths ie shrapnel, phosphorous, other hazardous/reactive/sharp objects so pressing down like that may well kill them. This is why a half tilt is always used to check what the obstruction is before proceeding.
    I fail to see how doing a jaw thrust is at all dangerous, let alone may kill someone!

    A good jaw thrust can make or break ventilation. I'm surprised to hear it be described as having not a lot of advantage!
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    Lifeguard - Spinal injury should be kept straight, ideally strapped to a spinal board. Do a log roll if you need to clear the mouth, otherwise its a chin lift + slowly tilting head back until you can get rescue breaths in.
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    (Original post by FabulouslyAwks)
    Also if you suspect sharp objects like needles in pockets, do you remove them using gloves or something?
    No, you don't even try to remove them.

    Your safety takes priority over that of the casualty.
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    (Original post by Etomidate)
    I fail to see how doing a jaw thrust is at all dangerous, let alone may kill someone!
    If they got shrapnel caught in their throat during an explosion or have burn centres due to close proximity to chemical detonations ie smoke grenades or signal flares applying pressure pushes it deeper in or shifts some of the chemical causing more damage and potentially death particularly as they may also have exterior shrapnel damage. Thats the basic reason, there is a bit more in detail but cba lol.
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    (Original post by GonvilleBromhead)
    If they got shrapnel caught in their throat during an explosion or have burn centres due to close proximity to chemical detonations ie smoke grenades or signal flares applying pressure pushes it deeper in or shifts some of the chemical causing more damage and potentially death particularly as they may also have exterior shrapnel damage. Thats the basic reason, there is a bit more in detail but cba lol.
    Sounds like complete nonsense to me!
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    (Original post by GonvilleBromhead)
    Can't tell you a lot about civilian first aid but military procedure is to apply common sense albeit from a reservist so take it with a pinch of salt =P. The airway should be cleared by a chin tilt anyway, if its a liquid obstruction then you're better to use the recovery position or - if you have help - log roll them to clear it. With any spinal injury log rolls are the best principle. If its a gripping obstruction ie you cant clear it by tilting or reaching into their gob then recovery won't help anyway. There's no reason to recovery a spinal injury unless they have a catastrophic bleed or other more pressing issue. We have always been told jaw thrusts are a load of rubbish, if you need them its for biochem burns or extreme blockage like shrapnel (it does happen) but I dont know civilian guidance. A half tilt can be used, just open their mouth and check for obstructions - if there are none then all is good, if there are some then thats priority so do a full tilt. Again all common sense really.

    As for sharp objects remove them if you can but dont risk yourself. You dont need a special bag or anything just get them out of the way. We had someone get injured with a knife in their smock pocket whilst training and it just got lobbed into the grass so we could treat them. Be more cautious depending on the situation ie if its a drug addict who has collapsed make 100% sure not to stab yourself removing the syringe
    First aid taught to non-medics in the military is not exactly useful to the OP who presumably is a civilian.

    As to your point about chin lifts being useful i presume you're in a role which doesn't use airway adjuncts as the evidence for the use of a jaw thrust in the setting of a suspected high spinal injury is pretty conclusive and an airway adjunct removes the requirement for a person to remain at the head end.
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    (Original post by plrodham1)
    First aid taught to non-medics in the military is not exactly useful to the OP who presumably is a civilian.

    As to your point about chin lifts being useful i presume you're in a role which doesn't use airway adjuncts as the evidence for the use of a jaw thrust in the setting of a suspected high spinal injury is pretty conclusive and an airway adjunct removes the requirement for a person to remain at the head end.
    I know, it got dragged out of context when i gave basic advice. Gotta love the internet =P

    Nope, thats combat medic. We do get some of their training as specialised infantry as we are expected to operate out of range of medics but thats basically above my understanding. I know what one is and our issue packs have a tube for creating one but its really not recommended, its if we have literally no other choice especially with the normal types of damage sustained.

    (Original post by Etomidate)
    Sounds like complete nonsense to me!
    Well tell that to a ten year veteran of the medics corps brought in specifically to teach us =P It might be but I'm not going to argue with him lol.
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    (Original post by GonvilleBromhead)
    I know, it got dragged out of context when i gave basic advice. Gotta love the internet =P

    Nope, thats combat medic. We do get some of their training as specialised infantry as we are expected to operate out of range of medics but thats basically above my understanding. I know what one is and our issue packs have a tube for creating one but its really not recommended, its if we have literally no other choice especially with the normal types of damage sustained.



    Well tell that to a ten year veteran of the medics corps brought in specifically to teach us =P It might be but I'm not going to argue with him lol.
    You don't need a tube to "create" a jaw thrust. I think you might be getting something mixed up. There's also no way a jaw thrust alone would force anything further into anyone's airway.
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    from a purely lay -person first aider point of view - i.e. what you would be taught on a 'public course'

    head tilt and chin lift

    and turn into the recovery position


    the risks of moving the head in the suspicion or even presence of the spinal injury are now felt to have been greatly overstated in the past - hence the changes in practice in the ambulance service and emergency departments over the use ( or otherwise) or extrication boards, scoop stretchers and cervical extrication collars ...
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    (Original post by Helenia)
    You don't need a tube to "create" a jaw thrust. I think you might be getting something mixed up. There's also no way a jaw thrust alone would force anything further into anyone's airway.
    No i meant we have tubes to create an adjunct. The pressing down motion supposedly can cause further damage if there are sharp objects lodged due to the nature of the press putting pressure on the face, this becomes particularly relevant if there is exterior damage also as there tends to be if someone gets caught in an explosion.

    I'm sorry I replied now lol, I have rudimentary combat first aid skills and everyone is telling me off :eek:
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    (Original post by GonvilleBromhead)
    No i meant we have tubes to create an adjunct. The pressing down motion supposedly can cause further damage if there are sharp objects lodged due to the nature of the press putting pressure on the face, this becomes particularly relevant if there is exterior damage also as there tends to be if someone gets caught in an explosion.

    I'm sorry I replied now lol, I have rudimentary combat first aid skills and everyone is telling me off :eek:
    I realise that you've borne the brunt of this, but I do think somewhere along the line in your teaching something has got confused. A jaw thrust doesn't involve a "pressing down motion" on the face - it's all about lifting the lower jaw up and away. Applied properly, it is a potentially lifesaving manoeuvre, even in someone with external or internal injuries/foreign bodies - though they are likely to need more definitive airway management anyway, you can buy time with simple moves.

    I'm not quite sure what you're envisaging when talking about jaw thrusts, or why they would particularly make someone "man down" compared with other moves. If someone is injured enough to need airway protection, they aren't going to be returning to combat any time soon no matter what you do to them.

    In answer to the OP's question, jaw thrust is one option, though the patient needs to be pretty deeply unconscious to tolerate it. Alternatively log rolling is still an option and as Zippy says, over-zealous C-spine protection is going out of fashion now (though don't say this in an exam!)

    COI: I'm an anaesthetist, so airway management is pretty much my thing. I don't do combat medicine but do handle civilian major trauma and understand enough of the principles to know when something just doesn't make sense!
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    (Original post by Helenia)
    I realise that you've borne the brunt of this, but I do think somewhere along the line in your teaching something has got confused. A jaw thrust doesn't involve a "pressing down motion" on the face - it's all about lifting the lower jaw up and away. Applied properly, it is a potentially lifesaving manoeuvre, even in someone with external or internal injuries/foreign bodies - though they are likely to need more definitive airway management anyway, you can buy time with simple moves.

    I'm not quite sure what you're envisaging when talking about jaw thrusts, or why they would particularly make someone "man down" compared with other moves. If someone is injured enough to need airway protection, they aren't going to be returning to combat any time soon no matter what you do to them.

    In answer to the OP's question, jaw thrust is one option, though the patient needs to be pretty deeply unconscious to tolerate it. Alternatively log rolling is still an option and as Zippy says, over-zealous C-spine protection is going out of fashion now (though don't say this in an exam!)

    COI: I'm an anaesthetist, so airway management is pretty much my thing. I don't do combat medicine but do handle civilian major trauma and understand enough of the principles to know when something just doesn't make sense!
    You could well be right, the point of infantry is not to get hit =P. All I know is they say the movement is damaging for bad piercing or biochem wounds, it might be a case of we are not proper medics so get rudimentary training, idk. As for sending someone down, if those wounds are worsened you cant put somebody back in - if they aren't depending on medical assessment people can be put back in if they choose to be so (most do). We have always been taught tilt or nada, something about the thrust is supposedly endangering in certain situations though we only do BLS so its more focused on catastrophic bleeds and the like or resort to something or other (forget what its called) where you dislocate the jaw to free the airway.
 
 
 
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