Dr.

Didik Sugiyatno

RESUSCITATION TOOLS &

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

Hard palate
Oral cavity

Palatine
glands Soft palate
Pharyngeal
tonsil

Palatine
tonsil
Body of
tongue
Epiglottis
Aditus of
larynx Thyroid

Nasopharynx
Oropharynx
Retropharyngeal
space
Transverse
arytenoid
muscle
Cricoid
cartilage
Esophagus

cartilage Vocal
Trachea

FIG. 18-1. The anatomic airw

FIG. 18-2. An oral airway.

FIG. 18-3. Nasal airways.

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

Inflation line to
proximal cuf
stylet in long
tube
Short tube

Teeth strap
Proximal cuf

Inflation valve and

adaptor-both cufs
inflated
simultaneously
Inflation line
to
distal cuf

Distal cuf
Distal end
of
short tube

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

Combitube. C. Tracheoesophageal airway (used with permission)

FIG. 18-6. A. Laryngeal mask

airway (LMA). B. LMA diagram
showing placement at the larynx
(used with permission).

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

with
permission).
Bilevel
Positive Airway Pressure

Oral axis

Oral axis

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

B. Sniffing position.

Elevat
e
occipu
t
10 cm

Thyroid
cartilag
ePoint
of
injecti
Thyroi
on
d
gland

Superior
thyroid
artery
Cricothyroi
d
artery
Cricothyroi
d
membrane
Cricoid
cartilag
e

FIG. 19-2. Translaryngeal anesthesia via

cricothyroid puncture. Anatomy, anterior view.

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

endoscope

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.

FIG. 20-1. Tracheostomy tube with obturator.

Thyroid Cartilage
Hyoid Bone
Cricothyroid
Membrane
Cricoid
Cartilage

Chin
Cricothyroid
Membrane
Manubrium

FIG. 20-2. A. Anatomy of the

neck. B. Location of the
cricothyroid membrane.

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

membrane and stabilizing the laryngeal cartilages.

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 the cricothyroid
membrane.

FIG. 20-5. Surgical cricothyroidotomy.

Puncturing the cricothyroid
membrane with a scalpel blade.

FIG. 20-7. Surgical cricothyroidotomy.

Placement of tracheostomy tube with
obturator.

FIG. 20-8. Needle cricothyroidotomy.

Puncturing the skin with needle and
catheter

FIG. 20-10. Needle cricothyroidotomy.

Endotracheal setup with tube,
syringe, and catheter.

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

and syringe.

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

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

extremities.

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.)

FIG. 21-6. A. Posterior approach for

internal jugular venipuncture. B. Central
approach.
C. Anterior approach. (Reproduced with
permis
sion from Textbook of Advanced Life
Support, 2d ed. Dallas: American Heart

FIG. 21-7. Infraclavicular

subclavian venipuncture.

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. Proximal
and 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. The vein
is stretched flat and incised at a 45
degree angle. Approximately onethird of the lumen
must be exposed. (Reproduced with
permission from Roberts JR, Hedges
JR: Clinical Procedures in Emergency
Medicine, 2d ed. Philadelphia:
Saunders, 1991, p. 321. Parts B and C
first appeared in Vander Salm TJ, et
al: Atlas of Bedside Procedures.

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 of with
this technique.

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.