Trendelenburg position

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Old description of the Trendelenburg position.

In the Trendelenburg position, the body is laid flat on the back (supine position) with the feet higher than the head by 15-30 degrees, 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 hypovolemic shock.2

Trendelenburg position In Surgery.

Uses

  • People with hypotension (low blood pressure) have historically been placed in the Trendelenburg position in hopes of increasing their cerebral perfusion pressure (the blood pressure to 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.
  • The brain does not have any musculature structures to provide the necessary movements and pressures to return the blood to the heart. This loss of circulation in the brain due to the Trendelenburg position can actually be a detriment to the tissues instead. Gravity normally returns the blood to the heart from the brain.
  • The Trendelenburg position is used in waterboarding to prevent water entering the lungs which allows the interogator to bring the prisoner to a condition of extreme pain and loss of airway, thus leaving no hematomas or other physical signs of the inflicted pain and trauma.
  • 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.
  • The Trendelenburg position is also used in respiratory patients to create better perfusion.11
  • The Trendelenburg position is also used in CIA torture : At least five detainees were subjected to the process, the report states. The report details how accused USS Cole bomber Abd al-Rahim al-Nashiri was placed “in a forward facing position (Trendelenburg) with head lower than torso”, whilst undergoing rectal feeding.12

Another detainee, Majid Khan, a legal resident of the United States and accused confident of Khalid Sheikh Mohammed, was also subjected to rectal feeding. According to a CIA cable released in the report, his “‘lunch tray’ consisting of hummus, pasta with sauce, nuts and raisins was ‘pureed and rectally infused’”.

See also

References

  1. ^ Enersen, Ole Daniel. "Trendelenburg's position". Whonamedit.com. Retrieved 2009-03-04. 
  2. ^ Emerg Med J 2010;27:877-878 doi:10.1136/emj.2010.104893 http://emj.bmj.com/content/27/11/877.extract
  3. ^ Bridges N, Jarquin-Valdivia AA (September 2005). "Use of the Trendelenburg position as the resuscitation position: to T or not to T?". Am. J. Crit. Care 14 (5): 364–8. PMID 16120887. Retrieved 2009-03-19. 
  4. ^ "BestBets: Use of the Trendelenburg Position to Improve Hemodynamics During Hypovolemic Shock". 
  5. ^ Terai C, Anada H, Matsushima S, Kawakami M, Okada Y (June 1996). "Effects of Trendelenburg versus passive leg raising: autotransfusion in humans". Intensive Care Med 22 (6): 613–4. doi:10.1007/BF01708113. PMID 8814487. 
  6. ^ Johnson S, Henderson SO (January 2004). "Myth: the Trendelenburg position improves circulation in cases of shock". CJEM 6 (1): 48–9. PMID 17433146. Retrieved 2009-03-19. 
  7. ^ Stonier, JC (1985). "A study in prechamber treatment of cerebral air embolism patients by a first provider at Santa Catalina Island". Undersea Biomedical Research (Undersea and Hyperbaric Medical Society) 12 (1 supplement). Retrieved 2009-03-19. 
  8. ^ Pulley, Stephen A. "eMedicine - Dysbarism". Retrieved 2008-03-15. 
  9. ^ Buchwald H (January 1998). "Three helpful techniques for facilitating abdominal procedures, in particular for surgery in the obese". Am. J. Surg. 175 (1): 63–4. doi:10.1016/S0002-9610(97)00233-X. PMID 9445243. Retrieved 2009-03-19. 
  10. ^ Amesur, Nikhil B. "eMedicine - Central Venous Access". Retrieved 2008-03-15. 
  11. ^ Powers SK, Stewart MK, Landry G (1988). "Ventilatory and gas exchange dynamics in response to head-down tilt with and without venous occlusion.". Aviat Space Environ Med 59 (3): 239–45. PMID 3355478. 
  12. ^ http://www.theguardian.com/us-news/2014/dec/09/cia-torture-methods-waterboarding-sleep-deprivation?CMP=fb_gu/

External links


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