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Ambi-hi-lo Chamber Manual

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A bag valve mask (BVM), sometimes known by the proprietary name Ambu bag or generically as a manual resuscitator or "self-inflating bag", is a hand-held device commonly used to provide positive pressure ventilation to patients who are not breathing or not breathing adequately. The device is a required part of resuscitation kits for trained professionals in out-of-hospital settings (such as ambulance crews) and is also frequently used in hospitals as part of standard equipment found on a crash cart, in emergency rooms or other critical care settings. Underscoring the frequency and prominence of BVM use in the United States, the American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care recommend that "all healthcare providers should be familiar with the use of the bag-mask device."[1] Manual resuscitators are also used within the hospital for temporary ventilation of patients dependent on mechanical ventilators when the mechanical ventilator needs to be examined for possible malfunction or when ventilator-dependent patients are transported within the hospital. Two principal types of manual resuscitators exist; one version is self-filling with air, although additional oxygen (O2) can be added but is not necessary for the device to function. The other principal type of manual resuscitator (flow-inflation) is heavily used in non-emergency applications in the operating room to ventilate patients during anesthesia induction and recovery.[citation needed]

Use of manual resuscitators to ventilate a patient is frequently called "bagging" the patient[2] and is regularly necessary in medical emergencies when the patient's breathing is insufficient (respiratory failure) or has ceased completely (respiratory arrest). Use of the manual resuscitator force-feeds air or oxygen into the lungs in order to inflate them under pressure, thus constituting a means to manually provide positive-pressure ventilation. It is used by professional rescuers in preference to mouth-to-mouth ventilation, either directly or through an adjunct such as a pocket mask.

The BVM consists of a flexible air chamber (the "bag", roughly a foot in length), attached to a face mask via a shutter valve. When the face mask is properly applied and the "bag" is squeezed, the device forces air through into the patient's lungs; when the bag is released, it self-inflates from its other end, drawing in either ambient air or a low pressure oxygen flow supplied by a regulated cylinder, while also allowing the patient's lungs to deflate to the ambient environment (not the bag) past the one way valve.[citation needed]

A bag valve mask can be used without being attached to an oxygen tank to provide "room air" (21% oxygen) to the patient. However, manual resuscitator devices also can be connected to a separate bag reservoir, which can be filled with pure oxygen from a compressed oxygen source, thus increasing the amount of oxygen delivered to the patient to nearly 100%.[4]

An endotracheal tube (ET) can be inserted by an advanced practitioner and can substitute for the mask portion of the manual resuscitator. This provides more secure air passage between the resuscitator and the patient, since the ET tube is sealed with an inflatable cuff within the trachea (or windpipe), so any regurgitation is less likely to enter the lungs, and so that forced inflation pressure can only go into the lungs and not inadvertently go to the stomach (see "complications", below). The ET tube also maintains an open and secure airway at all times, even during CPR compressions; as opposed to when a manual resuscitator is used with a mask when a face mask seal can be difficult to maintain during compressions.[citation needed]

Under normal breathing, the lungs inflate under a slight vacuum when the chest wall muscles and diaphragm expand; this "pulls" the lungs open, causing air to enter the lungs to inflate under a gentle vacuum. However, when using a manual resus


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