resuscitation tools and technique

8/9/2019 Resuscitation Tools and Technique

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RESUSCITATION TOOLS & TECHNIQUE

Dr. Didik Sugiyatno

Source : Emergency Medicine, a comprehensive study guide, by Judith E Tintinaly


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Hard palate

Oral cavity

Palatine tonsil

Body of tongue

Epiglottis

Aditus of larynx

Thyroid

cartilage Vocal

Trachea

Palatine glands

Soft palate

Pharyngeal tonsil

Nasopharynx

Oropharynx

Retropharyngeal space

Transverse arytenoid

muscle

Cricoid cartilage

Esophagus

FIG. 18-1. The anatomic airway.


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FIG. 18-2. An oral airway. FIG. 18-3. Nasal airways.


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FIG. 18-4. Bag-valve-mask unit.


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FIG. 18-5. A. Pharyngotracheal lumen airway. B. Esophageal tracheal Combitube. C.

Tracheoesophageal airway (used with permission)

Inflation line to proximal cuff

stylet in long tube

Short tube

Teeth strap

Proximal cuff

Inflation valve and

adaptor-both cuffs

inflated simultaneously

Inflation line to

distal cuff

Distal cuff

Distal end of

short tube


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FIG. 18-6. A. Laryngeal mask airway (LMA).

B. LMA diagram showing placement at the

larynx (used with permission).


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FIG. 18-7. A patient with severe COPD on nasal BiPAP (used with permission).

Bilevel Positive Airway Pressure


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Oral axis

FIG. 19-1. A. Oral, pharyngeal, and laryngeal axes. B. Sniffing position.

Oral axis

Elevate

occiput10 cm


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Superior

thyroid artery

Cricothyroid

artery

Cricothyroidmembrane

Cricoid

cartilage

Thyroid

cartilage

Point of

injection

Thyroid

gland

FIG. 19-2. Translaryngeal anesthesia via cricothyroid puncture.

Anatomy, anterior view.


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FIG. 19-3. A fiberoptic laryngoscope and a Shikani endoscope


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Class I Class II Class III Class IV

FIG. 19-4. Classification of tongue size relative to the size of the oral cavity as described by

Mallampati and colleagues.17 Class I: Faucial pillars, soft palate, and uvula can be

visualized. Class II: Faucial pillars and soft palate can be visualized, but the uvula is masked

by the base of the tongue. Class III: Only the base of the uvula can be visualized. Class IV:

None of the three structures can be visualized.


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FIG. 20-1. Tracheostomy tube with obturator.


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Thyroid Cartilage

Cricothyroid Membrane

Cricoid Cartilage

Hyoid Bone

Chin

Cricothyroid Membrane

Manubrium

FIG. 20-2. A. Anatomy of the neck. B.

Location of the cricothyroid membrane.


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FIG. 20-3. Surgical cricothyroidotomy. Palpating the cricothyroid membrane and

stabilizing the laryngeal cartilages.


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FIG. 20-4. Surgical cricothyroidotomy. Incision

between the cricoidand thyroid cartilages

FIG. 20-6. Surgical cricothyroidotomy. Placing

the scalpel handle to widen the hole in thecricothyroid membrane.


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FIG. 20-5. Surgical cricothyroidotomy.

Puncturing the cricothyroid membrane with a

scalpel blade.

FIG. 20-7. Surgical cricothyroidotomy.

Placement of tracheostomy tube with

obturator.


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FIG. 20-8. Needle cricothyroidotomy.

Puncturing the skin with needle and catheter

FIG. 20-10. Needle cricothyroidotomy.

Endotracheal setup with tube, syringe, and

catheter.


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FIG. 20-9. Needle cricothyroidotomy. Catheter in place with adapter and syringe.


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FIG. 21-1. Veins of the upper extremity.

FIG. 21-2. Veins of the torso and lower extremities.


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FIG. 21-4. Coronal section through the midclavicle.

FIG. 21-5. Seldinger technique of catheter insertion (wire-

guided). (Reproduced with permission from Conahan TJ III,

Schwartz AJ, Geer RT: Percutaneous catheter introduction: The

Seldinger technique.JAMA 237:446, 1977.)


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FIG. 21-6. A. Posterior approach for internal

jugular venipuncture. B. Central approach.

C. Anterior approach. (Reproduced with permis

sion from TextbookofAdvanced Life Support, 2d

ed. Dallas: American Heart Association, 1990, pp.

149-150.)


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FIG. 21-7. Infraclavicular subclavian

venipuncture.


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FIG. 21-8. Venous cutdown. A. A skin incision is

made perpendicular to the course of the vein.

B. Skin retracted and vein exposed. C. Proximaland distal ties are passed under the vein. If the

vein is to be sacrificed, the distal suture is tied

to prevent bleeding, and the ends are left long

to help stabilize the vein during cannulation.

The proximal tie is not tied at this point, but

traction on it will control back bleeding. D. Thevein is stretched flat and incised at a 45 degree

angle. Approximately one-third of the lumen

must be exposed. (Reproduced with

permission from Roberts JR, Hedges JR: Clinical

Procedures in Emergency Medicine, 2ded.

Philadelphia: Saunders, 1991, p. 321. Parts Band C first appeared in Vander Salm TJ, et al:

Atlas ofBedside Procedures. Boston: Little,

Brown, 1979.)


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FIG. 21-9. A "mini-cutdown." The vessel is

elevated with a hemostat and occluded with

gentle traction from a distal tie. The needle is

inserted and the sheath is advanced into the

vessel. The vessel should not be tied off with this

technique.


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FIG. 21-10. The needle is inserted 2 cm distal

to the tibial tuberosity on the medial aspect of

the tibia. It is inserted in a caudal direction,

away from the joint space.

FIG. 21-11. A tourniquet is placed around the

infant's head and the needle inserted 0.5 cm

from the intended puncture site in the

direction of blood flow.

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