The supine position or dorsal decubitus is an anatomical position in which the individual lies face up. The word "decubitus" has its origin in Latin decumbere, which means "to lie down" or "to lie down." "Supino" also has Latin origin in the word supinus, which is understood as being supported on the back or with the palm of the hand facing up.
The term supine also refers to a foolish, unreasonable or lazy person. Perhaps laziness refers to the supine position, since lying on the back is the typical body expression of someone who does not feel like getting up or doing any activity.
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This anatomical position, in addition to including lying on your back, has other peculiarities, including:
- Body in horizontal position parallel to the ground.
- Neutral neck position.
- Gaze up to the sky or ceiling. Technically described as gaze at the zenith.
- Arms close to the body.
- Legs extended with feet in neutral position. Fingertips point upward at an angle of approximately 75º.
There is some controversy regarding the situation of the hands. The concept of supination of the hands implies that the palms face upwards while in an anatomical position, but more often than not, while the body is in the supine position, the hands are prone with the thumbs facing the central axis of the body..
The parts of the body that support the supine position are the occiput, the back, the elbows, the buttocks, the back of the thighs, and the heels. This position is useful for virtually dividing the body into imperfect halves according to the three axes of the plane:
It divides the body into two parts, namely: ventral, the part of the body that is not supported and looks up; and dorsal, the part of the body resting on the surface.
It separates the body into two halves that are inaccurate from each other. The upper half, cranial or cephalic, is everything that is above the axis that cuts the body above an imaginary line that passes just above the iliac crests.
On the other hand, the lower or caudal half is basically represented by the lower limbs and the pelvis..
Divides the body into two theoretically equal halves, right and left, as long as the axis accurately crosses the midline of the body.
Many clinical activities make use of the supine position to achieve their goals. Among the most important activities we have the following:
The supine position is the most used in surgical procedures. Many specialties approach the patient while in such a position, such as general surgery, chest surgery, head and neck surgery, trauma, gynecology and obstetrics, cardiovascular surgery and urology. Anesthesiologists intubate the patient primarily in that position.
Many imaging studies are done with the patient lying on their back. Not only basic radiographs or X-rays, but also most CT scans and MRIs are done with the patient supine. The same goes for abdominal and pelvic ultrasounds..
A significant number of physiotherapeutic techniques are carried out in the supine position. In fact, bedridden patients receiving physical therapy are compulsorily lying on their backs. Communication with the patient is much better if they lie in this position while the exercises or maneuvers are being performed..
Several dental procedures are carried out with the patient in the supine position or one of its variations. Even maxillofacial surgeons prefer this position for most of their intraoral operations.
The death rate associated with sudden death syndrome in young children or infants has greatly decreased in recent years..
This decrease seems to be due to the fact that the most recent studies recommend avoiding the prone position to reduce the risk of rebreathing carbon dioxide.
The physical examination par excellence in any specialty is performed with the patient in this position. In the application of cardiopulmonary resuscitation maneuvers or CPR, the person is in the supine position. Even in pathological anatomy, autopsies are done with the patient lying on his back.
As can be seen, it is the most used patient position in the medical world, followed by far by the prone and lateral decubitus..
There are many accepted variations of the supine position for clinical use, such as the gynecological position, lithotomy position, Trendelenburg and its inverted, Fowler and semi-sitting variant..
While this position is very useful and versatile, not a few pathological conditions have been linked to it. Some of the most important are described below:
Obstructive sleep apnea has been shown to be more frequent and severe when people sleep on their backs.
This is due to an increased risk of collapse of the airway due to its more anterior location, lower lung volume and the inability of the respiratory muscles to maintain the luxury of permeable air..
Fetal bradycardia episodes occur during uterine contractions if the mother is in the supine position.
This was demonstrated by several studies in which they assessed fetal health in labor with mothers in supine or lateral decubitus position. The percentage of bradycardia decreased when the mother lay on her side.
Patients in the immediate postoperative period or with intestinal obstruction are at increased risk of aspiration if they are in the supine position..
If the intra-abdominal pressure overcomes the support of the esophageal sphincter, which is more likely if the person is lying on his back, the gastric contents can return to the esophagus and even pass into the airways.
Patients with advanced congestive heart failure cannot tolerate supine position. Orthopnea - breathing difficulties when the person is lying down - is a common symptom of heart failure related to the mismanagement of the volumes of blood reaching and leaving the heart..
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