The supine position (pronounced /ˈsuːpaɪn/) is a position of the body: lying down with the face up, as opposed to the prone position, which is face down, sometimes with the hands behind the head or neck. When used in surgical procedures, it allows access to the peritoneal, thoracic and pericardial regions; as well as the head, neck and extremities.[1]

Using terms defined in the anatomical position, the dorsal side is down, and the ventral side is up.

Lateral position

Sims' position, named after James Marion Sims is usually used for rectal examination, treatments and enemas. It is performed by having a patient lie on their left side, left leg extended and right leg flexed.

The word "prone," meaning "naturally inclined to something, apt, liable," has been recorded in English since

1382; the meaning "lying face-down" was first recorded in 1578, but is also referred to as "lying down" or "going prone."

"Prone" derives from the Latin pronus: "bent forward, inclined to," from the adverbial form of the prefix pro- "forward." Both the original, literal, and the derived figurative sense were used in Latin, but the figurative is older in English.

[edit] Anatomy

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.

lithotomy position is a medical term referring to a common position for surgical procedures and medical examinations involving the pelvis and lower abdomen, as well as a common position for childbirth in Western nations. The lithotomy position involves the positioning of an individual's feet above or at the same level as the hips (often in stirrups), with the perineum positioned at the edge of an examination table. References to the position have been found in some of the oldest known medical documents including versions of the Hippocratic oath (see lithotomy); the position is named after the ancient surgical procedure for removing kidney stones, gall stones and bladder stones via the perineum. The position is perhaps most recognizable as the 'often used' position for childbirth: the patient is laid on the back with knees bent, positioned above the hips, and spread apart through the use of stirrups.

The position is frequently used and has many obvious benefits from the doctor's perspective. Most notably the position provides good visual and physical access to the perineal region. The position is used for procedures ranging from simple pelvic exams to surgeries and procedures involving, but not limited to reproductive organs, urology, and gastrointestinal systems. New observations and scientific findings, combined with a greater sensitivity to patient needs have raised awareness of the physical and psychological risks the position may pose for prolonged surgical procedures, pelvic examinations, and, most notably, childbirth.

Contents

[hide]

1 Lithotomy position, prolonged surgical procedures and circulatory complications

2 Lithotomy position and pelvic exams 3 See also 4 References 5 External links

[edit] Lithotomy position, prolonged surgical procedures and circulatory complications

Some studies have found a significant relationship between prolonged surgical procedures with the patient in

the lithotomy position and a circulatory complication known as "compartment syndrome",[1] "...a condition in which increased tissue pressure within a limited tissue space compromises the circulation and function of the contents of the space."[2] Nerve injury by pressure is also possible, the femoral or peroneal nerve are at risk.[3]

[edit] Lithotomy position and pelvic exams

Patients have reported feeling a loss of control and increased sense of vulnerability when examined in the lithotomy position because they cannot see the area being examined. Other, equally effective positions have been suggested for examinations of conscious patients.[4][5]

[edit] See also

In the Trendelenburg position the body is laid flat on the back (supine position) with the feet higher than the head, in contrast to the reverse Trendelenburg position, where

the body is tilted in the opposite direction. This is a standard position used in abdominal and gynecological surgery. It allows better access to the pelvic organs as gravity pulls the intestines away from the pelvis. It was named after the German surgeon Friedrich Trendelenburg.[1] It is not recommended for the treatment of hypovolaemic shock.[2]

Contents

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1 Uses 2 See also 3 References 4 External links

[edit] Uses

Hypotensive patients (patients with low blood pressure) have historically been placed in the Trendelenburg position in hopes of increasing their cerebral perfusion pressure (the blood pressure in the brain). A 2005 literature review found the "Literature on the position was scarce, lacked strength, and seemed to be guided by 'expert opinion.'"[3] A 2008 meta-analysis found adverse consequences to the use of the Trendelenburg position and recommended it be avoided.[4] However, the passive leg raising test is a

useful clinical guide to fluid resuscitation and can be used for effective autotransfusion.[5]

The Trendelenburg position used to be the standard first aid position for shock.[6]

The Trendelenburg position was used for injured scuba divers.[7] Many experienced divers still believe this position is appropriate, but current scuba first aid professionals no longer advocate elevating the feet higher than the head. The Trendelenburg position in this case increases regurgitation and airway problems, causes the brain to swell, increases breathing difficulty, and has not been proven to be of any value.[8] "Supine is fine" is a good, general rule for victims of submersion injuries unless they have fluid in the airway or are breathing, in which case they should be positioned on the side.

Perhaps because of its effect on breathing difficulty and airway problems, the Trendelenburg position is used in waterboarding.

The Trendelenburg position may be used in childbirth when a woman's cervix is too swollen and won't quite dilate to 10 centimeters, or during the incidence of a prolapsed umbilical cord to take pressure off the cord and get more oxygen to the fetus, or it can be used to help rotate a posterior fetus either during pregnancy or the birth itself.

Trendelenburg position is helpful in surgical reduction of an abdominal hernia.[9]

The Trendelenburg position is also used when placing a Central Venous Line.[10] Trendelenburg position uses gravity to assist in the filling and distension of the upper central veins when placing a central line in the internal jugular or subclavian veins. It is also used in the placement of an external jugular peripheral line for the same reason. It plays no role in the placement of a femoral central venous line.

[edit] See also

The reverse Trendelenburg, also called the anti-Trendelenburg, is a common surgical position in which the lower extremities are leveled lower than the head and neck. It is the opposite of the Trendelenburg position, in which the head and the neck are below the lower extremities. The reverse Trendelenburg is used in numerous surgical procedures and presents multiple benefits, as well as some risks.

History

1.The reverse Trendelenburg is a variation of the Trendelenburg position, which was introduced by German surgeon Friedrich Trendelenburg. The Trendelenburg position was first used in the 1860s to improve visual access of the pelvis and lower abdomen during surgery.

Reverse Trendelenburg Position

2.A patient is laid flat on a surgical table in the head-up, feet-down position. The patient must be tilted in and out of the reverse Trendelenburg position slowly to avoid sudden shifts in blood pressure. A secure padded foot rest at the base of the surgical table prevents the patient from slipping off. The patient is additionally restrained by a body sheet placed firmly around the arms, foot restraints and a foot board. Malnourished and elderly patients may require additional sheepskin booties or padding at the heels to protect them from pressure points. Legs must remain uncrossed to decrease the risk of thrombosis and relieve pressure.

Considerations

3.The reverse Trendelenburg is an unnatural position, and complications can occur. Patients

should not be left unattended while in the position, for they are liable to slide off the table. Excessive pressure may cause vital signs, such as blood pressure, temperature, heart rate and pulse, to drop, so the patient must be constantly monitored.

Effects

4.Reverse Trendelenburg has little effects on respiration but compromises the circulation of blood. A considerable volume of blood is pooled towards the lower extremities, resulting in reduced cardiac output.

Uses

5.The reverse Trendelenburg position is used to treat venous air embolism, improve the flow of blood to the cerebral regions, achieve an effective level of epidural or spinal anesthesia, prevent pulmonary aspiration due to vomiting and engorge vessels of the cervix for the placement of a central venous catheter. The position is also used for neck and head surgery and gynecological procedures because it reduces the flow of blood to those areas. The reverse Trendelenburg facilitates respiration in overweight and obese patients. Putting an overweight patient in the position alleviates pressure on the head

due to the excessive weight of the abdomen during ophthalmic surgery. The reverse Trendelenburg position is also used to improve surgical exposure of the prostate and in minimally invasive upper abdominal procedures.

Read more: What Is Reverse Trendelenburg? | eHow.com http://www.ehow.com/about_6771355_reverse-trendelenburg_.html#ixzz1GGcywd2T

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return to previous pageSupine    Someone in the supine position is lying on his or her back.

Prone    Someone in the prone position is lying face down.

Right Lateral Recumbent    The Right lateral recumbent, or RLR, means that the patient is lying on their right side.

Left Lateral Recumbent    The left lateral recumbent, or LLR, means that the patient is lying on their left side.

Fowler's Position    A person in the Fowler's position is sitting straight up or leaning slightly back. Their legs may either be straight or bent.  A ‘high fowlers’ position is somewhat who is sitting upright.  A ‘low fowlers’ position is someone whose head is only slightly elevated.

Trendelenberg Position    A person in the Trendelenberg position is lying supine with their head slightly lower than their feet.

Abduction    Abduction is movement away from the midline, or to abduct.

Adduction    Adduction is movement toward the midline, or to add.

Flexion    Flexion is to bend at a joint, or to reduce the angle.

Extension    Extension is to straighten at a joint, or to increase the angle, for example, from 90 degrees to 180 degrees.

Medial Rotation    Medial rotation is to turn inward.

Lateral Rotation    Lateral rotation is to turn outward.

Supination    Supination is to rotate the forearm so that the palm faces forward.

Pronation    Pronation is to rotate the forearm so that the palm faces backward.

Tripod Position

Child assuming tripod position. (Illustration by Jason M. McAlexander, MFA. Copyright © 2007 Wild Iris Medical Education.)One position that the (quite wonderful) medtrng.com site does not mention is the ‘tripod’ position.When people sit like this - with their hands on their knees and their elbows out, leaning forward - it's because they are very short of breath and struggling to get enough air.  There's a big difference between someone who is just 'sitting', which we will often describe as 'sitting comfortably', and someone who is 'tripoding'.Any patient who is tripoding is struggling to breath, and that should worry you.Incidentally, here's a clinical pearl for you.  If you find a patient sitting high fowlers with their legs crossed it's a pretty good sign that they are not in any distress.  Don't take that as an unbreakable law or anything - but many clinicians have noticed over the years that folks who are really in trouble don't lie

back with their legs crossed.  Usually, only people who are relaxed do that.

The images and most of the text on this page were taken from http://www.medtrng.com/posturesdirection.htm in April 2008.

LOW FOWLER’S

Terms Definitions

Disuses Syndrome

signs and symptoms that result from inactivity

Postureposition of the body or the way in which it is held

Muscle Spasms

sudden forceful, involuntary muscle contractions

Body Mechanics

efficient use of the musculoskeletal system or the use of proper body mechanics

Functional alignment that maintains the

Mobilitypotential for movement and ambulation

An Inactive Patient

position should be changed every 2 hours

Common Positions

(1)supine position, (2) lateral position, (3)lateral oblique position, (4)prone position, (5)sims position, (6)fowlers position

Supine Position

patient lies flat on back, could lead to skin breakdown and foot drop

Lateral Position

side-lying position, pillow under head, under arm at stomach and under calf

Lateral Oblique Position

variation of the side-lying position, pillow under head, calf and for support for the back

Prone Position

patient lies on the abdomen, pillow under head, stomach and feet

Sim's Position

semi-prone position, pt lies on the left side with the right knee drawn up toward the chest, left arm in

positioned along patient's back, chect and abdomen are allowed to lean forward, pillow under head, right arm and right calf

Fowler's Position

semi-sitting position, 30, 45, 60 and 90 degree angle

Low Fowler's Position

the head and torse or elevated to 30 degrees

Mid Fowler's Position

elevation of up to 45 degrees

High Fowler's Position

an elevation of 60 to 90 degrees

Positioning Devices

adjustable bed, mattress, bed board, pillows, roller sheet, trochanter rolls, hand rolls, footboards, boots, foot splints, trapeze

Protective Devices

side rails, foam/gel mattress, static air mattress, alternating air mattress, water mattress, cradle, low air loss bed, air fluidized bed,

oscillating support bed, circular bed

Foam/gel Mattress

acts like a layer of subcutaneous tissue because it conforms to the clients body and acts like a cushion

Static Air Mattress

filled with a fixed volume of air, suspends client on a bouyant surface-distributing pressure on the underlying tissue

Alternating Air Mattress

similar to static air, but every other channel inflates as the next one deflates-relieves pressure over bony prominences

Water Mattress

supports body and equalized pressure per square inch over its surface-effect is maintained regardless of any shift in the clients position

Cradle

metal frame secured to or placed on the mattress-forms a shell over the clients lower legs to keep bed linen off the feet or legs

Low-Air-Loss contains inflated air sacs within

Bedmattress-maintains capillary pressure well below that which can interfere with blood flow

Air-fluidized Bed

contains collection of tiny beads with a mattress cover-beads are blown upward on warm air. When suspended, they dry beads take on the characteristics of fluid, allowing the client to float on the lifted beads

Oscillating Support Bed

slowly and continuously rocks the client from side to side in a 124 degree arc. Relieves skin pressure and help to mobilize respiratory secretions

Circular Bed

supports the client on a 6 or 7 foot anterior or posterior platform suspended across the diameter of the frame

Transfer moving a client from place to place

Transfer Devices

transfer hand, transfer belt, transfer board, mechanical lift

Transfer serves as a combination grab bar

Handle

and handrail to support the client's weight while exiting and returning to bed. Not considered a restrictive device

Transfer Belt

padded device secured around the clients waist, it's handles provide a means of gripping and supporting the client

Transfer Board

serves as a supportive bridge between two surfaces such as a bed and wheelchair

Mechanical Lift

special equipment used to lift and move or lift and weigh a person

Function of Protective Devices

protects inactive clients from harm or complication

Specialty Beds

used to prevent other problems associated with inactivity and immobility

Active Transfer

when the client assist in transfers or movements

Passive Transfer

when the client is given assistance with movement or transfers

Ambulation walking

Dangling

act of suspending something, let clients legs dangle on the side of the bed after sitting client up before assisting client to wheelchair or walker

Draw Sheet

a turning sheet, used for turning, lifting or moving residents up in bed, prevents skin damage caused by shearing

Shearing removing by cutting off or clipping

Gait Beltwould use to move a patient from a standing position to a wheelchair

bed board,Rigid board placed under the mattress that gives firmer support to patients with back problems

hemiplegia paralysis of one side of the body

inversion the act of turning inside out

gurney a metal stretcher with wheels

litterconveyance consisting of a chair or bed carried on two poles by bearers

orthopneic position [ôr′thopnē′ik] Etymology: Gk, orthos, straight, pnoia, breath; L, positio

a body position that enables a patient to breathe comfortably. Usually it is one in which the patient is sitting up and bent forward with the arms supported on a table or chair arms. Also called orthopnea posture. Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.

1. orthopneic positionThe position assumed by patients with orthopnea, namely sitting propped up in bed by several pillows. ... Synonym: orthopnea position. ... (05 Mar 2000) ... Found on http://www.mondofacto.com/facts/dictiona

2. orthopneic positionorthopneic position The upright, or nearly upright, position of the upper trunk of a patient in a bed or chair. It facilitates breathing in those with congestive heart failure and some forms of pulmonary disease.Found on http://www.wordinfo.info/words/index/inf

3. orthopneic positionType: Term Definitions: 1. the position assumed by patients with orthopnea, namely sitting propped up in bed by several pillows. Synonyms: orthopnea positi

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