Note from Dr. Sztajnkrycer: Although 15–20 g dietary-equivalent glucose tablets were identified as the best first-aid option based on four studies, lack of availability should not deter the use of other sugars, despite the weak recommendation, in a symptomatic hypoglycemic patient who is conscious, able to follow commands, and able to swallow.

Positioning (FA 517)

Recommendation Author: Sean O’Rouke, MD

Dr. O’Rouke is a member of the residency training class of 2018 at Wake Forest School of Medicine.

Question: Among adults who are breathing and unresponsive outside of a hospital (P), does positioning in a lateral, side-lying recovery position (I) compared with supine position (C) change overall mortality, need for airway management, stridor, the incidence of aspiration, the likelihood of cervical spinal injury, complications, or incidence of cardiac arrest (O)?

Results: Eight observational studies that addressed the PICO were identified but were all deemed very-low-quality evidence.

Outcomes: There is limited evidence to suggest the lateral decubitus position improves morbidity or mortality, with very-low-quality evidence to suggest a lower incidence of aspiration, increased total lung volume, or decreased stridor. Several studies have identified different positioning methods with very-low-quality evidence of benefit from these alternative positions.

Discussion: On arrival to a scene with injured or ill persons, first responders must protect these individuals from continued harm. Actions to safely position patients are guided by several variables. In a person who is unresponsive and breathing normally without evidence of serious injuries, consider placing the person in the lateral decubitus position. If a person is unresponsive and not breathing normally, resuscitation efforts should begin immediately. Furthermore, if there is concern for neck, back, hip, or pelvic injury, the person should be left in the position in which they were found to avoid further injury.

Recommendation: Although there is little evidence to suggest the optimal recovery position, consider placing the unconscious person who is breathing normally in a lateral decubitus position.

Note from Dr. Stopyra: This is one of those common-sense recommendations. If uninjured, place the patient in a position that makes it easy to clear their airway should they vomit. A different recommendation debunks the “feet-elevated” position for shock (FA 520).

Oxygen Use in First Aid (FA 519)

Recommendation Author: Shannon Mumma, MD

Dr. Mumma is a member of the residency training class of 2018 at Wake Forest School of Medicine.

Question: Among adults and children who exhibit symptoms of shortness of breath, difficulty breathing, or hypoxia outside the hospital (P), does administration of oxygen (I) compared with no administration of oxygen (C) change survival with favorable outcomes, shortness of breath, time to resolution of symptoms, or therapeutic endpoints (O)?