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Now, we're going to cover the unconscious breathing victim in the workplace and how to implement the recovery position safely. Now in this scenario, we need to make sure our scene is safe, our gloves are on, and our rescue mask's available in the one-way valve, and then do a little bit of a detective work. We know he's laying here on the ground, so could he have just passed out? Sure. Could he have low blood sugar? Yeah, for sure. Could he have a had seizure? Yes. But, there's obviously a tool on the actual workbench that has an open wire. So, is there a chance that he was electrified? Absolutely. And that makes more sense than anything else. So we might even want to look for fractures, burns, entry and accident areas where the electricity came in and came back out. But the one thing that we know right away is when we assess this person, they were unresponsive, but they were breathing normally, they had good skin color. So this was not an immediate CPR situation. However, because there are unresponsive, they did not respond to my taps and shouts, I'm still going to activate EMS. "You in the plaid shirt, go call 911 and come back. I might need your help. Bring an AED with you, if you find one." And then before I even touch the person, what did I really need to look out for? Scene safety that still might be risk to me. He was electrocuted. Is the cable still touching him? Is the wire still touching him? Is she still electrified? So we made sure that anything carrying energy was de-energized, before I even tapped the patient themselves. Now once I assess them for breathing, and they are breathing normally, I need to help protect that airway that's being used to bring the air into their lungs, in case they vomit. In case they have blood in their mouth. I don't want it to go into their lungs, I want it to come out of their mouth, while we're waiting for EMS to arrive. So, how do we do that? The recovery position is done like this: As long as there are no fractures to these bones that I'm going to be moving, I can move them. As long as I don't expect a serious neck or back injury, I can move them. So, I don't suspect any of that stuff and I'm not seeing any deformities, so I'm going to go ahead and log role them. Now I bring the arm that's closest to me up, as I just did. I bring the leg that's furthest away over and across his ankles, and then I go underneath his head and neck, as I bring his wrist with his hip, and I draw him towards me. I now bring the leg that's closest to me up, like a kickstand, relieve the pressure of his head from my hand, as I escape that out. I bring his arm underneath, and then I kind of lean him towards the ground. I do this so that he won't roll all the way over, but I do it so that there's gravity working with us, now against him. I want fluids that come into his mouth or up from his stomach to have come out of his mouth and onto the ground. Not choking him, not obstructing the airway. The recovery position is a great way to have this type of person lay while we're waiting for EMS to respond. But at the first point that we think this person stops breathing or losing their pulse, we're going to role them right back on to their back, and we're going to start CPR. If we think they might be going into shock, we cover them with a sheet cutter blanket, and then we spend the rest of our time reassessing them continuously for responsiveness, for airway, breathing, and circulation.
In this lesson, you'll learn how to safely use the recovery position, for those times when you encounter a patient who is breathing but unconscious.
The recovery position is used in the following scenario:
- The patient is unresponsive
- The patient is breathing normally
- The patient has good skin color, good circulation
- It's not an immediate CPR situation
How to Put a Patient into the Recovery Position
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim.
In this situation the patient is unresponsive to your taps and shouts, which elicits an immediate 911 call and finding and/or preparing an AED for use, as you begin to assess the scene for clues of what happened.
The patient could have ended up unconscious for a number of reasons:
- Passed out or fainted
- Suffering from low blood sugar
- Seizure
- Electrocution
Warning: If you suspect electrocution, take extra measures to make sure the scene is safe. Is the power source still active? Is it still touching the patient?
To help keep the patient's airway open and clear, put them into the recovery position using the following steps:
Warning: Only use the recovery position if you don't suspect fractures, or serious neck and back injuries.
- Elevate the arm closest to you and bring it up over the patient's head before placing it on the ground.
- Bring the patient's furthest leg over their other leg so that their legs are crossed.
- Grab the wrist of the furthest arm and the hip together, while placing your other hand under the head and neck and roll the patient toward you and onto their side.
- Support the head while you place the patient's outstretched arm under their own head and with the chin pointing down, allowing gravity to help clear the airway.
- Bend the patient's top leg to a 90-degree angle at the knee, essentially creating a kickstand to help protect the patient from rolling over.
Pro Tip #1: The purpose of the recovery position is to expel any foods or liquids that come up. What comes up needs to come out. If it doesn't, it could find its way into the patient's lungs.
The recovery position is also a great way for the patient to lay safely while waiting for EMS. Using the patient's leg as a kickstand allows his or her body to use gravity without the threat of them rolling completely over.
Pro Tip #2: You want gravity working with you as you wait for EMS to arrive. It's important to eliminate the risks of the patient choking or an obstructed airway. Having the patient facing downward will help negate those risks.
Warning: If the patient loses their pulse or stops breathing, immediately roll them onto their back and start CPR.
Continue to reassess the patient while you wait for EMS to respond, particularly for signs of shock, responsiveness, airway, breathing, and circulation. And treat accordingly should the situation change.
A Word About the Signs of Inadequate Breathing
Inadequate breathing requires careful monitoring. You may not notice all of the signs and symptoms at once, and some can be hard to spot. If you see any of them, be prepared to give assisted ventilation.
When the patient has to expend too much effort to breathe and their breathing has become inadequate, you'll notice the following signs:
- Muscles between the ribs pull in when the patient breathes in. As the patient enhales, you may notice the muscles pulling inward between the ribs, above the collarbone, around the muscles of the neck and below the rib cage.
- Pursed lips breathing. The patient exhales through pursed lips, like a whistling motion. This maneuver helps control the patient's breathing pattern.
- Flaring out of the nostrils on inhalation can be a sign of inadequate breathing in children and infants.
- Apparent signs of fatigue are also an indication of labored breathing.
- Excessive use of abdominal muscles to breathe, as in when the patient is using the abdominal muscles to force air out of the lungs.
- Sweating and anxiousness are also signs of severe respiratory distress.
- A patient who is sitting upright and leaning forward with hands on knees could be doing so because they're struggling to breathe.
Abnormal breathing sounds are also a great sign of inadequate breathing. Listen for abnormal sounds such as wheezing or crackling. Wheezing or whistling sounds indicate restricted air flow and are common with conditions such as asthma, allergic reactions, and emphysema. If the patient has a fine cracking sound on inhalation, that may indicate fluid in the lungs.