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So now we are going to have a quick look at postural drainage. Remember, when a patient is lying on their back, and especially when a patient is lying on their back and unconscious, the biggest problem we have is fluid or stomach contents draining into the back of the throat and occluding the airway due to fluids. Also happens with blood or anything else liquid. So when we transfer a patient or travel with a patient, we are always better with them slightly sat up. That will keep any contents down into the stomach rather than floating back into the airway. Also remember that if we have got a patient travelling that is on oxygen, the mask itself will stop any fluid or vomit being projected away from the airway. So it will basically fill the mask, they will take the next breath in, they will inhale it into the lungs and suffer from aspirational pneumonia. Aspirational pneumonia itself is a killer. So we may have done a fantastic job of resuscitation and actually contribute to the patient's demise by filling the lungs with fluid at a later date.

So if a patient starts to have an airway problem, the first thing we want to do is to remove the mask itself completely away from the airway, that way if they vomit, it is not going to fill the mask and they are not going to inhale it. If there is no risk, the mask is fine. The next thing we can do to pre-empt the problem or to reduce the problem is to take one hand and place it under the back of the patient's head. By putting the patient in that position, we slightly lift the head on the hand, but we also prepare them just in case we need to posturally move them and posturally drain the airway. We have talked about suction, but the quickest way to clear an airway always is if we can actually drain it naturally.

If you get somebody that has an awful lot of fluid coming to the back of the throat that has been in a pub and had five or six pints of beer, that fluid will drain to the back of the throat and the suction unit will take a couple of minutes potentially to actually clear that amount of fluid, whereas if I can roll the patient on the stretcher and drain that fluid out onto the floor, I can clean the airway within a few seconds. So by putting the hand onto the back of the head, we prepare the patient for a move that needs to be done quickly. When this happens, we have got to recognize it fast because if we don't, the patient vomits vertically, drops back into the face, they take the next breath in and it is too late, that fluid has been sucked into the lungs.

The next thing we will do with this patient is we will raise the knee on the opposite side and actually what we are doing is preparing them really for a recovery position, because the recovery position, the whole idea of the recovery position, is so that the patient posturally naturally drains their airway. In the recovery position, the tongue falls forward, the jaw falls forward, and fluid drains out naturally through the mouth and airway itself without us having to do anything else, which is why post-resuscitation or with unconscious casualties until the emergency services arrive that are breathing, we put them in the recovery position to maintain that airway. On the back of the ambulance, we can use a similar technique to posturally drain. So with the arm under the back of the head, we raise the opposite knee and we can actually tuck the foot underneath the leg opposite so they are in that position.

All we need to do now is to lift the wrist across the chest and press down on the knee, as you would in the recovery position, making sure that you stay to the side of the stretcher and the stretcher side is actually locked in place. What happens now, very simply and very easily, the patient rolls to the side, vomits to the floor, drains the airway, and then we release the pressure and the patient goes back on to the stretcher into a normal position.