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'Pressure cycled resuscitators', as they
were known in the past (i.e. 'Stephenson Minuteman'), were designed
to operate upon the following principle. An inspiratory phase
would be initiated upon activation of flow of oxygen, usually
at a constant flow rate. The inspiratory flow would continue
until a fairly low preset pressure point was reached (approximately
15-20 cmH2O). Upon this preset pressure limit being
reached, the resuscitator then reverses function and begins
to create a negative circuit pressure which empties the lungs
of their pressurized contents. This process continues until
a negative pressure of -2 to -6 cmH2O is present
in the patient's airway, causing the resuscitator to switch
back to an inspiratory flow. The low preset inspiratory pressure
limit of 15-20 cmH2O would result in a tidal volume
of 400 ml to 1500 ml in an adult, depending on lung compliance
and lung volume.
As designed, these devices cycled automatically, however they
produced a number of undesirable characteristics, as follows:
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Due to the low single preset pressure
cycling limit, the device would trigger prematurely if
the patient has poor lung compliance and/or extremely
high airway resistance. This would result in inadequate
volume delivered to the patient. |
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The expiratory phase is terminated
only when a negative airway pressure is reached. This
can lead to complications, as serious as a collapsed lung. |
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If chest compressions are performed
when an inspiratory cycle begins the system would immediately
switch to expiratory mode, again delivering no significant
volume to the patient and subsequently waiting for completion
of the exhalation phase. |
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These systems, as designed in the
past, provide little or no adjustments or variable settings
to provide the responder with the ability to overcome
variable patient conditions in an emergency. |
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Since these devices create a negative
mode during expiration, they consume a tremendous amount
of the available supply of oxygen from a pressurized tank,
therefore reducing the usable supply of oxygen which could
have been delivered to the patient. |
The Oxylators®
EM-100
Oxylator®
EM-100
(herein after called the Oxylator®), functions with two
distinct functional elements (pressure/flow) during a ventilatory
cycle. The first is similar to the inspiratory phase of pressure
cycled devices described above, with one important and fundamental
difference: the Oxylator® has the capability to provide
adequate ventilatory volumes when a patient has high airway
restriction or poor lung compliance. This is possible due to
the fact that the Oxylator® incorporates a patented feature
which allows the user to increase and optimize the pressure
limit during inspiration prior to switching to the expiratory
phase. This feature is not found on any other resuscitator presently
available. Therefore, the claims made in recommendations as
to the inability of inadequate volume delivery DOES NOT apply
to the Oxylator®. The fact that one particular functional
phase is similar to another device's should not be grounds for
evaluation of functional criteria. In a recent discussion with
Dr. A. Sinclair of the Bureau of Medical Devices (Canada), he
confirmed the need to define the Oxylator® under a new category
in order not to misrepresent the Oxylator®'s capability
as done under a 'pressure cycled' category.
As mentioned above, the system has two specific elements which
trigger each of the inspiratory/expiratory phases. The first,
is the pressure limiting during the inspiratory cycle; this
initiates the expiratory phase. The second is flow (exhalation).
During the expiratory phase, the Oxylator® will NOT start
a new inspiratory cycle until exhalation phase is complete.
This eliminates the complications which result from 'stacked
breaths'. The end of the expiratory phase then triggers the
next inspiratory cycle, hence the new INSPIRATORY PHASE IS FLOW
TRIGGERED.
The design of the Oxylator® provides some unique features
some of which can be found only on higher priced ventilators.
The Oxylator® also has some unique features which provide
the CPR responder total 'Resuscitation Management' in the hands
of EMTs and trained caregivers.
Some of the key features are listed below. It should be kept
in mind that the Oxylator® was designed specifically to
provide the utmost flexibility, safety, and effectiveness by
combining all the features of a resuscitator and a first response
ventilator in one small, handheld unit.
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The system provides the caregiver
the ability to select the maximum pressure limit during
the inspiratory phase of a ventilatory cycle. |
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As a constant flow generator it
provides safe administration of oxygen either with a mask
or endotracheal tube. |
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It provides the caregiver 'feedback',
to alert instantly of airway blockage and inadequate ventilation. |
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Its design allows the caregiver
to maintain better mask seal and reduces fatigue when
used in its 'automatic mode'. |
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When the system is used simultaneously
during chest compressions, it synchronizes the cycling
modes to the compressions automatically, providing safe
and effective two man CPR technique, as recommended under
BLS guidelines. |
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Minimal PEEP is maintained (<
4 cmH2O) when used in the automatic mode. |
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Allows the caregiver to switch to
manually activated ventilatory cycles if confronted with
patients that demonstrate abnormal lung compliances. |
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Provides inhalation function when
resuscitation is no longer required, this can be overridden
automatically if resuscitation is to be re-initiated. |
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Simple construction allows the user
to disassemble the top and bottom components instantly
with no tools to ensure proper cleaning and disinfection
of the system. |
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Provides a trained caregiver the
ability to monitor and detect deterioration or improvement
of a patient's condition (respiratory) simply from cycling
rate changes. |
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The system accommodates a particle
or viral-bacterial filter disc to be inserted into the
patient connection if desired. |
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The Oxylator® completely eliminates
the potential of 'stacked' breaths, or gradual increase
in PEEP levels which may occur with time/volume cycled
systems, its expiratory phase allows passive, unassisted
exhalation. |
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The minute volume will always be
maintained when the system is in automatic mode, regardless
of changes to the pressure limit settings. |
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During the ventilatory cycle, the
system always maintains a positive pressure in the airway,
unless a negative pressure is initiated by the patient's
own effort at which point it allows the patient to satisfy
their own demand. |
| • |
Due to its patented design, the
Oxylator® will automatically cycle with a patient's
own rhythm, and wastes no time in 'detecting' failure
of a patient's own inspiratory effort. |
| • |
Its unique design utilizes ONLY
ONE moving component as it cycles, which 'floats', thereby
virtually eliminating any wear factor or possibility of
malfunction. |
The system has numerous features built into a small, handheld
unit. The Oxylator® has been tested (benchtesting and clinical
testing) globally, and is sold worldwide, demonstrating its
capability to provide the emergency caregivers an advanced 'RESUSCITATION
MANAGEMENT SYSTEM'. |
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