Rose position is a position in which a patient is placed while undergoing a tonsillectomy, adenoidectomy or uvulopalatopharyngoplasty. In this position both the head and neck are extended. This is done by keeping a sand bag under the patient’s shoulder blade. For a patient with a kyphosis or a stiff neck, raise the head piece of the table so that the head ring really does support the head. Its contraindicated in patients with syndrome owing to atlanto-axial instability.
Rose position is used in
- Flexible esophagoscopy
- Direct laryngoscopy
Rose position: patient lies supine with pillow under the shoulder for extention of the neck and head. This position is used for the tonsillectomy. Tracheostomy is also done in the same position. In direct laryngoscopy and bronchoscopy the head is extended but neck is flexed which is called as barking dog position. Rigid esophagoscopy is also done in the same position. However, flexible esophagoscopy is done in left lateral position.
Advantages of Rose Position
- There is virtually no aspiration of blood or secretions into the airway
- Both hands of the surgeon are free. This position helps in proper application of the Boyles Davis mouth gag
- The surgeon can be comfortably seated at the head end of the patient
The recovery position refers to one of a series of variations on a lateral recumbent or three-quarters prone position of the body, into which an unconscious but breathing casualty can be placed as part of first aid treatment. An unconscious person, a person who is assessed on the Glasgow Coma Scale at eight or below, in a supine position (on the back) may not be able to maintain an open 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.
Six key principles to be followed:
- The casualty should be in as near a true lateral position as possible with the head dependent to allow free drainage of fluid
- The position should be stable
- Any pressure of the chest that impairs breathing should be avoided
- It should be possible to turn the victim onto the side and return to the back easily and safely, having particular regard to the possibility of cervical spine injury
- Good observation of and access to the airway should be possible
- The position itself should not give rise to any injury to the casualty
Purpose of Recovery Position
The recovery position is designed to prevent suffocation through obstruction of the airway, which can occur in unconscious supine patients. The supine patient is at risk of airway obstruction from two routes:
Mechanical obstruction: in this instance, a physical object obstructs the airway of the patient. In most cases, this is the patient’s own tongue, as the unconsciousness leads to a loss of control and muscle tone, causing the tongue to fall to the back of the pharynx, creating an obstruction. This can be controlled (to an extent) by a trained person using airway management techniques
Fluid observation: fluids usually vomit; can collect in the pharynx, effectively causing the person to drown. The loss of muscular control which causes the tongue to block the throat can also lead to the stomach contents flowing into the throat, called passive regurgitation. Fluid which collects in the back of the throat can also flow down into the lungs. Another complication can be stomach acid burning the inner lining of the lungs, causing aspiration pneumonia.