26.6b Proper Positioning

supine

Trauma patients are often confined to the (?) position as a result of spinal immobilization measures.

flexibility

However, some circumstances can warrant ?, if local clinical guidelines permit.

seated

For example, patients with facial and airway trauma who are able to maintain their airway as long as they are sitting up can be placed in a cervical collar in a ? position rather than being restricted to a supine position.

position of comfort

Conscious medical patients should be maintained in their ? if they are not placed in a spinal motion restriction (SMR) device.

aspiration

Unconscious medical patients who do not require other interventions, such as BVM ventilation, should be placed on their side with the head elevated (if not contraindicated) to minimize the risk of ?.

ear-to-sternal-notch position

Unconscious patients who do require airway and ventilation interventions, such as BVM ventilation or intubation, are usually best maintained in an ? in which the supine patient’s head is elevated to the point where the ear and the sternal notch are horizontally aligned (Figure 22-38).

sniffing position, ramped position

This position is often referred to as the ? in nonobese patients and the ? in obese patients.

upper airway patency

With both of these positions, the ear-to-sternal notch alignment is maintained to maximize ? allowing for effective ventilation and, if required, endotracheal intubation.

mechanics of ventilation

It also improves the ? with both spontaneous breathing and BVM ventilation.

slightly flexing the patient’s neck and extending the head

To place nonobese patients in the sniffing position, first achieve an ear-to-sternal notch horizontal alignment by ? (assuming no cervical spine injury is suspected).

towel or small pillow

This can be maintained by placing a ? under the head

obese patients

The strategy for positioning ? is different.

entire upper portion of the body

It is often difficult or impossible to place them into the sniffing position by elevating just the head. Instead, you must elevate the ?.

blankets, towels, and regular or commercial wedge pillows

This can be achieved by using ?

proper ramp

When considering airway management in obese patients, prepare a ? (head and shoulder support) before transferring them to the ambulance.

lifting

? obese patients during airway management is often difficult.