What is First Aid?

First aid is the provision of initial care for an illness or injury. It

is usually performed by a non-expert person to a sick or injured
person until definitive medical treatment can be accessed.
Certain self-limiting illnesses or minor injuries may not require
further medical care past the first aid intervention. It generally
consists of a series of simple and in some cases, potentially life-
saving techniques that an individual can be trained to perform
with minimal equipment.
While first aid can also be performed on all animals, the term
generally refers to care of human patients.

Recovery Position

The recovery position or coma position refers to one of a series

of variations on a lateral recumbent or three-quarters prone
position of the body, in to which an unconscious but breathing
casualty can be placed as part of first aid treatment.
An unconscious person in a supine position (on their back) may
not be able to maintain a patent airway as a conscious person
would. This can lead to an obstruction of the airway, restricting
the flow of air and preventing gaseous exchange, which then
causes hypoxia, which is life threatening. Thousands of
fatalities occur every year in casualties where the cause of
unconsciousness was not fatal, but where airway obstruction
caused the patient to suffocate. The cause of unconsciousness
can be any reason from trauma to intoxication from alcohol.

Prone Position

In anatomy, the prone position is a position of the body lying

face down. It is opposed to the supine position which is face up.
Using the terms defined in the anatomical position, the ventral
side is down, and the dorsal side is up.
With respect to the forearm, prone refers to that configuration
where the palm of the hand is directed posteriorly, and the
radius and ulna are crossed.

Recumbent

Semirecumbent position protects from pulmonary aspiration

but not completely from gastroesophageal reflux in
mechanically ventilated patients. The term "recumbent" comes
from the Latin words "re" (to lie back) and "cuber" (to lie down).
Recumbent is another term often used to describe the
decubatus positions. Recumbent means lying down or reclining.
It is often used interchangeably with the term decubitus.

Semi - Recumbent Position

Purpose: Positioning mechanically ventilated patients in an

adequate semi-recumbent position is a low cost and apparently
easy applied measure to prevent new VAP. We performed an
unannounced audit to compare the actual backrest angle
with the target backrest angle of 30-45 degrees,
assess whether compliance was better in patients whose bed
had a built-in bedside protractor, and document diffi culties
reported when failing to achieve the target backrest angle.

Methods: From 1/3/2007 to 30/6/2007, unannounced ad hoc

inspections were made on patients receiving mechanical
ventilation in the intensive care unit. During inspections, the
angle of elevation of bed was formally measured by a manual
technique using a hand-held protractor. The nurse at bed-
side was also asked to estimate the angle of elevation of bed
without referring to the built-in protractor andinterviewed with
a structured questionnaire. Results: From 1/3/2007 to
30/6/2007, inspections were made on 295 occasions. The
median angle of backrest elevation was 25 degrees
(interquartile range [IQR]: 20 to 30 degrees). The median
angle of elevation estimated by the nurse at the bed-side was
30 (IQR: 20 to 30 degrees), (p <0.001). Semi-
recumbent positions meeting the 30 degree minimum target
angle were observed on only 120 (41%) occasions. Reasons
provided for failing to achieve the target angle included
incorrect estimation of the backrest angle and interference of
the semi-recumbent position with nursing procedures and
nursing inconvenience.

Conclusions: This audit showed that the minimum target semi-

recumbent position of 30 degrees was achieved only 40% of
the time in an academic intensive care unit. Nurses at bedside
consistently overestimated the angle of elevation of bed, and
the presence of a built-in bedside protractor was not associated
with a greater compliance with the target backrest elevation
angle. Strictly enforced protocols,education programs for
nurses and doctors and regular audit may improve compliance
with backrest elevation targets.

Upright Position

Patients with acute respiratory distress syndrome (ARDS) have

dorsal atelectasis of the lungs. This is probably caused by
several mechanisms: compression on dependent lung zones,
purulent secretions in alveoli, and upward shift of the
diaphragm. An upright position (UP) of the patient (the whole
body in a straight line at 40 to 45 degrees) can theoretically
ameliorate these mechanisms. The objective was to evaluate
whether there was an improvement of gas exchange during UP
of ARDS patients and to evaluate the hemodynamic effects. A
prospective interventional study was performed in the surgical
and medical ICUs and the burn unit of the Ghent University
Hospital, a tertiary care center. Included were ARDS patients
with onset of ARDS within 48 hours before start of the study.
Patients were excluded when there was hemodynamic
instability or when the PaO2/FiO2 ratio deteriorated during the
2 hours preceding UP. After a 2-hour observation period in a
semirecumbent position, patients were put in UP for 12 hours.
Respiration and hemodynamic data were recorded at the start
and end of the 2-hour observation period, and after 1, 4, and
12 hours in UP. Eighteen patients were included in the study.
There was a significant increase of the PaO2/FiO2 ratio during
UP (P< .001). Except for the need for volume resuscitation in 5
patients (27.8%), there was no significant change in the
hemodynamic profile of the patients. Upright positioning of
patients with ARDS, a relatively simple maneuver, resulted in
an improvement of gas exchange and was tolerated
hemodynamically relatively well during a 12-hour observation
period.