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of ventilation, largely due to concerns of potential over-inflation with the demand valve by untrained rescuers. The ambu-bag, unlike the older version of the demand valve (all new models of demand valve now have pressure relief valves set at 60 cm of water to prevent accidental overinflation of the lungs), has a "pop-off" valve to prevent inflation at greater than 40 pounds -per-square-inch (275.79 kilo-pascals), with the result being that it is generally more common in the pre-hospital setting than the demand valve. However, the demand valve remains popular with BLS providers, and in situations where conserving supplies of oxygen is of paramount importance. The demand valve, while less popular today than it was previously, still remains in service, albeit with important safety features added, including the addition of a pressure-relief valve to prevent over-inflation and the restriction of its flow to 40 liters a minute.
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spontaneously breathing patient. These devices work like full blown transport ventilators yet are simple enough to operate that they can be used in an emergency situation by pre-hospital healthcare providers and are small enough to be easily transportable. Having a manual override control for use during mask CPR they meet the requirements of the current resuscitation standards. The
Oxylator (R) EM-100 introduced in the late 1990s and subsequently replaced by the more flexible Oxylator (R) EMX and HD are pressure cycled devices that utilize pressure, rather than time, cycling to ventilate the patient. More recently the microVENT resuscitator range introduced two new models, the microVENT(R) CPR and the microVENT(R)World. These two new time/volume resuscitators meet the latest requirements for resuscitation and are claimed to be lighter and smaller than most similar products.
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required to inflate the lungs could be achieved, and the demand valve was better able to detect obstructions in the lungs and more able to "work with the patient" than the
Emerson and Pulmotor could. The demand valve could also provide oxygen at any flow rate required to a conscious patient in respiratory distress. Conserving the often limited reserves of oxygen was easier with a demand valve, as oxygen was designed only to flow when either the button was depressed or the casualty inhaled. Later medical opinion decided that getting high flow oxygen into a patient's airway was a factor in causing vomiting and aspiration. Demand valve resuscitators were introduced with restrictors to limit flow rates to 40 lpm. Use of the demand valve resuscitator in Europe was limited by the lack of pressure relief valve or audible alarm for high pressure.
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drowning, however, the benefits outweighed the negatives, so these units found a home on ambulances around the world. The devices that cycled on the basis of upper and lower pressure limits are known as pressure cycled automatic resuscitators. In the UK the introduction of BS6850:1987 Ventilatory
Resuscitators confirmed that "....automatic pressure-cycled gas-powered resuscitators are not considered suitable for such use (closed chest cardiac compression)..." and confirmed the standards required for gas powered resuscitators and operator powered resuscitators. The following year a similar ISO standard was introduced. Around this date most manufacturers supplied or introduced time - volume cycled resuscitators and pressure cycled devices were discontinued.
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237:. It is a small portable device used in the pre-hospital setting to provide emergency ventilation to a patient who is either in respiratory failure or cardiac arrest. The pocket mask is designed to be placed over the lower face of the patient, creating a seal enclosing both the mouth and nose. Air is then administered to the patient by the responder who exhales through a one-way filter valve. The system is capable of delivering up to 16% oxygen with exhaled air.
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power a device which forced air into the patient's lungs. While better than no oxygen at all, these old units were problematic. Aside from often failing to sense obstructions in the airway, the
Emerson, and to a lesser degree the Pulmotor, were large, bulky and heavy. The Emerson Resuscitator required two strong men to carry it from the ambulance to the victim. Perhaps the greatest defect, however, was the fact that these units "cycled".
25:
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like the
Pulmotor were popular but yielded less than satisfactory results. Most modern resuscitators are designed to allow the patient to breathe on his own should he recover the ability to do so. All resuscitation devices should be able to deliver more than 85% oxygen when a gas source is available.
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resuscitator. These are driven by pressurized gas delivered by a regulator, and can either be automatic or manually controlled. The most popular type of gas powered resuscitator are time cycled, volume constant ventilators. In the early days of pre-hospital emergency services, pressure cycled devices
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was a further advancement in resuscitation. Introduced in the 1960s by the Danish company Ambu, this device allowed two rescuers to perform CPR and ventilation on a non-breathing patient with an acceptable chance of success. The ambu-bag has now mostly replaced the demand valve as the primary method
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Both the
Pulmotor and the Emerson depended to a large extent upon the patient's ability to breathe the oxygen in order to be beneficial. Due to the limitations imposed by the cycling feature, this meant that patients in need of rescue breathing benefited little from the application of these devices.
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Cycling was a feature that was built into most resuscitators built before the 1960s, including the
Pulmotor and Emerson models. To ensure that the victim's lungs were not injured from being over-inflated, the resuscitator was pre-set to provide what was considered a safe pressure of oxygen. Once the
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or EMS was developed. In these early days, perhaps the most advanced piece of equipment carried on these ambulances were devices for delivering supplemental oxygen to patients in respiratory distress. The
Pulmotor and later models, such as the Emerson Resuscitator, used heavy cylinders of oxygen to
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Resuscitators began in 1907 when
Heinrich Dräger, owner of the Drägerwerk AG Company, produced the "Pulmotor" Resuscitator. Considered to be the first practical device for delivering oxygen to unconscious patients or patients in respiratory distress, the Pulmotor influenced resuscitators for many
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Newer products have been developed and are available. In 1992 the
Genesis(R) II time/volume cycled resuscitator (now upgraded to meet the current, international, resuscitation guidelines and called the CAREvent(R) ALS and CA)provide the SIMV automatic ventilation mode with demand breathing for the
175:
Manual resuscitators, also known as bag valve masks, consist of a flexible oro-nasal face-mask with non-return valves and a large hand-squeezed plastic bulb using ambient air, or with supplemental oxygen from a high-pressure tank. The mask covers the mouth and nose, and has a peripheral seal that
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was impossible to perform if a patient's respiration was being supported by one of these units. If chest compressions were to be done, the cycle would be retarded and the resuscitator would be unable to provide oxygen as long as the chest was being compressed. For victims of smoke inhalation and
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The demand valve was a revolutionary new piece of equipment. At the push of a button, high-flow oxygen could be delivered into the lungs of the patient without the complication of the device cycling and, the associated chance of ceasing to administer oxygen. Any amount of pressure that might be
313:(COPD), or any form of obstructive lung disease, the delivered pressure was insufficient pressure to fill the lungs with oxygen, meaning that, for patients with any sort of obstructive lung disease, units that pressure cycled did more harm than good. Pressure cycling also meant that
240:
Modern pocket masks have either a built in one-way valve or a disposable filter to protect the operator responder from potentially infectious bodily fluids, such as vomit or blood. Many masks also have a built-in oxygen addition tube, allowing for administration of 50-60% oxygen.
535:, Lübeck, Germany (original manufacturers of the Pulmotor, and many other ventilation items, to the present day) (a lengthy, illustrated history of the development of artificial ventilation, interwoven with the publishers' own apparently self-promotional corporate history).
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Most established automatic resuscitator manufacturers developed time/volume cycled resuscitators as these are acknowledged as preferable to pressure cycled resuscitators.
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147:) consisting of a mask and a large hand-squeezed plastic bulb using ambient air, or with supplemental oxygen from a high-pressure tank. The second type is the
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The Emerson and Pulmotor were utilized until the mid-1960s, when a breakthrough in the history of oxygen delivery was made: the demand valve.
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A manual resuscitator should be used on a victim only in an environment where the air is unquestionably safe to breathe.
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When ambulance services began to form in major cities around the world, such as in London, New York and Los Angeles,
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A pocket mask, or pocket face mask or CPR mask, is an expired air resuscitation device used to safely deliver
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One of the first modern resuscitation ventilators was the HARV, later called the PneuPac 2R or Yellow Box.
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The first appearance of the expired air resuscitator type was the Brooke Airway introduced in 1957.
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565:"The Return of the Pulmotor as a 'Resuscitator': A Back-Step toward the Death of Thousands,"
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BS 6850:1987 British Standard Specification for Ventilatory resuscitators
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It began with the Pulmotor: One Hundred Years of Artificial Ventilation
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It began with the Pulmotor: One Hundred Years of Artificial Ventilation
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fits most face shapes, and is generally held in place by the operator.
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by John Bottrell (registered respiratory therapist), April 19, 2017,
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unit reached this limit, it ceased to pump oxygen. For patients with
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is a device using positive pressure to inflate the lungs of an
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585:, Lübeck, Germany (original manufacturers of the Pulmotor).
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Medical device using positive pressure to inflate the lungs
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458:
ISO 8382:1988 Resuscitators intended for use with humans
460:. International Organization for Standardization. 1988.
546:"1907: The first mechanical ventilator: The Pulmotor,"
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or breath powered resuscitator. The third type is an
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194: with: summary of main article. You can help by
49:. Unsourced material may be challenged and removed.
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137:and alive. There are three basic types: a
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109:Learn how and when to remove this message
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436:. British Standards Institution. 1987.
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296:Early "Lungmotor" resuscitation device
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567:by Yandell Henderson, December 1943,
560:Wood Library-Museum of Anesthesiology
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311:chronic obstructive pulmonary disease
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248:
178:
47:adding citations to reliable sources
18:
1124:Breathing performance of regulators
847:Continuous positive airway pressure
13:
721:Self-contained breathing apparatus
656:Mountaineering breathing apparatus
14:
1313:
1014:Surface-supplied diving equipment
726:Self-contained self-rescue device
633:High altitude breathing apparatus
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491:Meditech (B.N.O.S. Meditech Ltd.)
412:. Dragerwerk AG. pp. 10–11.
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1174:Respiratory protective equipment
1159:Open circuit breathing apparatus
748:Powered air-purifying respirator
674:Occupational breathing apparatus
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182:
23:
34:needs additional citations for
983:Underwater breathing apparatus
910:Respiratory gas humidification
684:
583:Dräger Medical AG & Co. KG
552:blog, retrieved April 12, 2020
533:Dräger Medical AG & Co. KG
450:
426:
1:
581:by Ernst Bahns, published by
531:by Ernst Bahns, published by
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335:
315:cardiopulmonary resuscitation
644:Aviation breathing apparatus
410:The Evolution of Ventilation
245:Oxygen powered resuscitators
7:
1302:Medical breathing apparatus
1169:Positive pressure breathing
1154:Negative pressure breathing
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826:Medical breathing apparatus
539:
471:CHANEY, G. (Nov 15, 1966).
378:"Pocket Mask Resuscitation"
10:
1318:
1139:Escape breathing apparatus
1065:User respiratory interface
803:GB2626 (China), and others
520:
487:"Manufacturer information"
302:Emergency medical services
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218:
168:
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1201:Closed circuit rebreather
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896:Built-in breathing system
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798:EN 149/14683/143 (Europe)
786:42 CFR 84 (United States)
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692:
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215:Expired air resuscitators
141:version (also known as a
905:Positive airway pressure
879:Non-invasive ventilation
133:, in order to keep them
1216:Carbon dioxide scrubber
1184:Constant flow regulator
1036:Atmospheric diving suit
952:Partial rebreather mask
716:Supplied-air respirator
649:Emergency oxygen system
356:Response considerations
768:Elastomeric respirator
733:Particulate respirator
297:
261:This section is empty.
160:Mechanism and function
1046:Helium reclaim system
1024:Helicopter escape set
1009:Full-face diving mask
515:Kiss of Life CPR Mask
408:Bahns, Ernst (2001).
295:
1134:Emergency gas supply
1029:Submarine escape set
165:Manual resuscitators
43:improve this article
1221:Semi-closed circuit
1164:Oxygen concentrator
932:Non-rebreather mask
915:Supplemental oxygen
891:Hyperbaric medicine
837:Anaesthetic machine
620:Breathing apparatus
473:US Patent 3,285,261
1179:Pressure regulator
994:Open-circuit scuba
755:Chemical cartridge
556:"Draeger Pulmotor"
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235:respiratory arrest
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1233:Escape respirator
1228:Work of breathing
1211:Oxygen rebreather
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1004:Diving rebreather
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383:. Archived from
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550:Asthma History
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219:Main article:
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171:Bag valve mask
169:Main article:
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129:person who is
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58:"Resuscitator"
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419:3-926762-17-9
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390:on 2011-07-17
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54:Find sources:
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32:This article
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1189:Demand valve
1041:Gas extender
962:Venturi mask
852:Resuscitator
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494:. Retrieved
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392:. Retrieved
385:the original
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123:resuscitator
122:
120:
105:
96:
86:
79:
72:
65:
53:
41:Please help
36:verification
33:
1206:Counterlung
1149:Hazmat suit
947:Oxygen tent
942:Oxygen mask
937:Oxygen hood
862:Pocket mask
842:Bubble CPAP
779:Regulations
759:Facepieces
496:18 December
221:Pocket mask
149:expired air
127:unconscious
1196:Rebreather
1129:Dead space
869:Ventilator
763:Smoke hood
697:and others
686:Respirator
394:2008-01-18
364:References
336:Modern day
135:oxygenated
69:newspapers
1144:Facepiece
1084:Half mask
874:Iron lung
743:Dust mask
272:July 2023
229:during a
203:July 2023
1296:Category
1280:Glossary
1256:Category
709:Canister
704:Gas mask
540:Pulmotor
342:ambu-bag
99:May 2014
1268:Commons
1109:General
1019:Snorkel
570:Science
521:General
289:years.
284:History
83:scholar
440:
416:
139:manual
85:
78:
71:
64:
56:
695:NIOSH
388:(PDF)
381:(PDF)
90:JSTOR
76:books
498:2014
438:ISBN
414:ISBN
340:The
62:news
267:.
233:or
198:.
45:by
1298::
558:,
489:.
121:A
612:e
605:t
598:v
572:.
500:.
475:.
446:.
422:.
397:.
274:)
270:(
205:)
201:(
112:)
106:(
101:)
97:(
87:·
80:·
73:·
66:·
39:.
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