امرأة عمرها ٦٦ سنة دخلت بالتهاب رئوي في الفص السفلي من الرئة اليمنى فقط، والأشعة تؤكد ذلك. حرارتها ٣٨٫٦، والتنفس ٢٦، وتشبعها ينخفض إلى ٨٩٪ على أكسجين ٣ لتر عندما تستلقي على ظهرها. أي وضعية تحسّن الأكسجة أكثر؟

A 66-year-old woman has right lower lobe pneumonia only, confirmed on X-ray. T 38.6 °C, RR 26, and her SpO2 drops to 89% on 3 L oxygen when supine. Which position improves oxygenation most?

1. Supine with the head of the bed flat
2. Trendelenburg, head down, to drain secretions
3. Right side-lying, so that the affected lung is down
4. Left side-lying, so that the healthy lung is down

Answer: D) Left side-lying, so that the healthy lung is down. In one-sided lung disease, gravity sends blood to the dependent lung, so placing the healthy lung down improves ventilation-perfusion matching. Placing the affected lung down worsens hypoxaemia, and lying flat or head-down splints the diaphragm.