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Why Left Lateral Recumbent?


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I thought everyone knew why left lateral recumbent position in the ambulance:::

So the pt pukes all over the medic in the back.

Only if the medic is a slow medic.

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I understand that the theory is LLR reduced pressure on the IVC, but would that shift all the weight onto the aortic arch and descending aorta? or are they assuming the pressure of the heart pumping is enough to overcome this?

You are not really shifting any weight onto the aortic arch as the arch is in the chest. In a pregnant woman, with a large intraabdominal parasite weighing several pounds, it is easy to collapse the IVC decreasing the blood flow to the heart and subsequently to the vital organs. If that parasite now sits on the left side where the aorta is less significant or has already branched (review the anatomy). A little decreased flow to the legs is no big deal if it allows you to perfuse the brain, heart, lungs and important intraabdominal organs.

EDIT: Wiki has an interesting article. Let's not forget the reason for the LLR position in non-pregnant people. It was used to prevent blockage of the airway in people who were not fully conscious and able to protect their airway.

http://en.wikipedia.org/wiki/Recovery_position

Edited by ERDoc
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You are not really shifting any weight onto the aortic arch as the arch is in the chest. In a pregnant woman, with a large intraabdominal parasite weighing several pounds, it is easy to collapse the IVC decreasing the blood flow to the heart and subsequently to the vital organs. If that parasite now sits on the left side where the aorta is less significant or has already branched (review the anatomy). A little decreased flow to the legs is no big deal if it allows you to perfuse the brain, heart, lungs and important intraabdominal organs.

EDIT: Wiki has an interesting article. Let's not forget the reason for the LLR position in non-pregnant people. It was used to prevent blockage of the airway in people who were not fully conscious and able to protect their airway.

http://en.wikipedia.org/wiki/Recovery_position

Of course, that pesky BLS airway.

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  • 2 months later...

Anatomically many of these are good reasons and make good sense when treating in the field.

I was originally taught, seems like a million years ago now, that left lateral recumbent position, from a cardiovascular point of view, was for perfusion in order to keep the heart in the lowest and thus best perfused position.

It still makes sense when you consider that shock, inadequate tissue perfusion, is due to either volume depletion or vasodilation. Thus keeping the heart in the most favorable position with gravity to perfuse the rest of the body still make good sense. As many have already noted, there is no perfect cookbook recipe for medicine in the field. Each situation requires a different modification to our treatment plan,and this is what separates the green medic from the well seasoned ones.

Thankfully experience, training, and forums like this make us all better seasoned.

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