numask combined product training presentation all rights reserved. © 2007-2011 numask®, inc
TRANSCRIPT
Table of Contents
IOM and OPA : Slides 3-34 Introduction: 3-7
Patient Selection: 8
Contraindications: 9
IOM Placement: 10-16
OPA Placement: 17-22
Standard Hand Grip (Modified CE): 23-25
Advanced Grips (Lateral, HOB): 26-32
Hand Grips (all): 33
Alt. IOM Placement: 34
CPR Kit: Slides 35-57 Introduction: 35-36
Placement: 37-44
Standard Hand Grip (Rescuer at side of victim): 45-48
Pediatric Hand Grip: 49
Advanced Hand Grip “Modified CE”: 50-53
Rescue Breaths: 54-56
CPR: 57
Retention Shield, CPAP/BiPAP: Slides 58-65 Introduction: 58-59
Placement: 60-62
Respiratory Circuitry/Hands Free
Ventilation: 63-64
Optional Nose Clip: 65
FAQs: Slides 66-87
Contact Information: 88
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NuMask IntraOral Mask (IOM®) & Oropharyngeal Airway (OPA)
Training Presentation
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The kit contains both the IOM and the OPA. The kit size (large or medium) is determined by the OPA size.
NuMask IOM®/OPA Kit
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NuMask IOM® & OPA
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The IOM is placed in the mouth, behind the lips, but in front of the teeth.
IOM® in position IOM® & OPA in position
Respiratory Arrest
Cardiac Arrest
Respiratory Failure CHF (congestive heart
failure) ARDS (acute respiratory
distress syndrome)
Non cardiogenic pulmonary edema
Asthma COPD (chronic obstructive
pulmonary disease) Pneumonia Aspiration Pulmonary Embolism
Altered Mental Status CVA (cerebral vascular
accident) ICH (intracerebral
hemorrhage) Sepsis Narcotic/sedative overdose Intoxicant overdose CO poisoning
Trauma Shock Leforte fractures Pneumothorax Hemothorax
Other Indications Conscious sedation Anesthetic induction Mask assisted OR cases Preoxygenation for emergent
or elective endotracheal intubation or placement of an LMA type device
Therapeutic induced hyperventilation
Patient Selection and Indications for Use
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Do not use or attempt to use in an actively vomiting patient. Do not use in patients with known allergies to PVC and non-latex
rubber. Do not use in patients who have loose or missing teeth/dental
prostheses without first stabilizing or removing them to prevent potential aspiration.
Do not use in patients with airway foreign bodies until such foreign bodies are removed.
Do not use the OPA in patients with an intact gag reflex.
Contraindications
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Patient Positioning – Head Tilt / Chin Lift
IOM® Placement
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IOM orientation – logo up in most patients (invert if severe underbite) Dentures, if secure, should be left in place
IOM® Placement
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Elevate lateral edge of the lips and slide in one flap
of the IOM under the lips but in front of the teeth
IOM® Placement
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One flap of IOM inserted and pushed laterally
IOM® Placement
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Grasp and elevate the other side of lips to insert remainder of IOM
IOM® Placement
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IOM® Placement
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Manipulation of IOM to improve seat (gently slide side-to-side / up and down)
Take care with OPA if it is present
Hold IOM stem while bracing hand on patient’s face and attaching resuscitator bag.
IOM® Placement
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The OPA should be used if airway obstruction is still evident despite proper head and neck positioning, i.e. “head tilt / chin lift” (if not contraindicated due to trauma, etc.).
With proper positioning, the great majority of patients should not require OPA use.
OPA Placement
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OPA Placement
The OPA is sized by placing it against the patient’s cheek and measuring from the front of the teeth to the angle of the mandible. There are multiple sizes of the OPA available. If the size you have selected does not fit, then trim to size.
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Trimming the OPA to size
Standard OPA insertion (insert and invert)
OPA Placement
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The IOM is inserted as previously described Take care not to displace OPA
OPA Placement
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IOM/OPA in correct position Visually confirm OPA position prior to start of ventilation
OPA Placement
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Lay the hand flat onto the face with the stem of the IOM and patient’s nose positioned between the thumb and index finger. Then wrap the rest of the hand and fingers around the jaw. These fingers may be used to provide jaw thrust.
Gently squeeze the lips and mouth around the stem while applying gentle, symmetric, downward pressure to obtain seal.
The nose is pinched between the base of the thumb and index finger as pictured.
Standard Hand Grip “Modified CE”
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(provider at head of patient)
Standard Hand Grip “Modified CE”(provider at head of patient)
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Standard Hand Grip “Modified CE”(provider at head of patient)
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The following grips allow easy ventilation for providers with small hands or from a lateral position to the patient.
Advanced Grips
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Lateral Grip Head of Bed (HOB) Grip
This grip is performed by cradling the patient’s chin with the palm, applying light pressure over the lips, and pinching off the nose with the thumb and index finger. The 5th finger can be placed under the jaw line for greater control/jaw thrust.
Advanced Grip
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(provider lateral to patient)
The action consists of pulling tissue from lips and face into the mask, rather than applying downward pressure.
Advanced Grip(provider lateral to patient)
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For providers with small hands, the stem of the IOM is placed between the ring and the middle finger or index and middle finger (depending on the size of the patient’s face and the provider’s hand). The nose is pinched between the thumb and side of index finger.
Advanced Grip – small hands
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(provider at Head of Bed – HOB)
Again, the action is more pulling tissue from lips and face into the mask, rather than applying downward pressure.
Advanced Grip – small hands
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(provider at Head of Bed – HOB)
The 5th digit may be used to provide additional jaw thrust/control. This is particularly important if the patient’s face is slippery from emesis/oil.
Advanced Grip – small hands
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(provider at Head of Bed – HOB)
All the hand grips allow for a great amount of control over the patient’s head and neck position.
Take advantage of this control to achieve proper “head tilt / chin lift” positioning.
All the grips generally require very little or no downward pressure (there may be need for slightly more if a patient’s face is slippery due to blood/emesis/oil).
Hand Grips
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An alternative method of IOM insertion is to sweep the lips over the mask flaps using a finger as pictured.
Caution: Use clinical judgment and do not put fingers in the mouth of combative, uncooperative or actively seizing patients.
Alternative IOM® Placement – finger sweep
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NuMask offers three CPR kits:
Basic, Hard Case, and Zippered Case.
The basic kit includes a CPR IntraOral Mask (IOM®) with one-way filtered valve and instruction guide, packaged in a poly bag.
The hard plastic case and ultra-compact zippered case kits both include the same contents: CPR IntraOral Mask (IOM®) with one-way filtered valve, premium nitrile gloves, wipe, and instruction guide packaged in their respective cases.
NuMask CPR Kit
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The IOM is placed in the mouth, behind the lips, but in front of the teeth.
CPR IOM® PlacementNuMask CPR IOM® properly placed.
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If not contraindicated, the victim should be placed in a head tilt/chin lift position.
CPR IOM® Placement
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The IOM should be inserted with the deep frenulum notch and NuMask label facing up in most victims with a normal overbite. The mask may be inverted in victims with a severe underbite.
If dentures are present and secure, they should be left in place.
CPR IOM® Placement
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Elevate lateral edge of the lips and slide in one flap of the IOM.
CPR IOM® Placement
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Initial flap of IOM inserted and pushed to the side.
CPR IOM® Placement
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Alternative finger sweep technique available (recommended only for trained medical providers). See IOM/OPA instructions for full description.
CPR IOM® Placement
Grasp and elevate the other side of lips to insert remainder of IOM.
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Manipulation of IOM to improve seat (gently slide side-to-side / up and down).
CPR IOM® Placement
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This grip is performed by cradling the victim’s chin with the palm, applying light pressure over the lips, and pulling them into the stem of the mask by bringing the fingers together. The 5th finger of this hand may be placed under the jaw line for additional jaw thrust/control. The other hand is used to close the nose by pinching it between thumb and index fingers.
Standard CPR Hand Grip(Rescuer at side of victim)
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The action consists of pulling tissue from the lips and face into the mask stem, rather than applying downward pressure.
Standard CPR Hand Grip(Rescuer at side of victim)
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The process and positioning in this grip is quite similar to mouth-to-mouth breathing. This means it is easier to learn and remember.
Standard CPR Hand Grip(Rescuer at side of victim)
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For pediatric and infant patients, simply place the IOM over the outside of the patient's lips with the patient's mouth open and apply the standard CPR grip.
Pediatric CPR Hand Grip
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Advanced CPR Hand Grip – “Modified CE”(Rescuer at head of victim)
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Lay the hand flat onto the face with the stem of the IOM and victim’s nose positioned between the thumb and index finger. Then wrap the rest of the hand and fingers around
the jaw. These fingers may be used to provide jaw thrust.
Advanced CPR Hand Grip – “Modified CE”(Rescuer at head of victim)
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Gently squeeze the lips and mouth around the stem while applying gentle, symmetric, downward pressure to obtain seal.
Advanced CPR Hand Grip – “Modified CE”(Rescuer at head of victim)
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The nose is pinched between the base of the thumb and index finger as pictured.
Advanced CPR Hand Grip – “Modified CE”(Rescuer at head of victim)
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Rescue Breaths - Pediatric(Rescuer at side of patient)
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Rescue BreathsModified “CE” Grip - Rescuer at head of victim
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The IOM should be left in place during compressions, allowing for a quick transition between rescue breathing and compression cycles.
CPR
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NuMask Retention Shield CPAP/BiPAP
Training Presentation
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The contents include one NuMask Retention Shield and instructional guide.
An optional nose clip is provided for the occasional case in which the retention shield does not fully occlude the nose.
NuMask Retention Shield Kit
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Retention Shield Placement
The NuMask Retention Shield is designed for use with the NuMask IntraOral Mask (IOM®). It is used to secure the mask in place, maintain mask seal, and occlude the nose.
The IOM is first placed by instructing an awake patient to do so by himself or herself, or as described in the IOM instructions. The Retention Shield’s hole is then placed over the stem of the IOM, bringing the shield surface down to the patient’s lips.
The shield notch goes up into the nose, and the raised surface of the shield hole contacts the lips.
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Retention Shield Placement
Using the Velcro fasteners, the lower shield strap is then snugly attached around the back of the patient’s neck.
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Retention Shield Placement
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Using the Velcro fasteners, the upper shield strap is snugly attached around the back of the patient’s head, bringing the soft edge
of the shield up to occlude the nose.
Standard CPAP/BiPAP or anesthesia circuitry may be attached directly to the IOM®.
Respiratory/Anesthesia Circuitry
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Alternatively, a resuscitator bag may be attached and used for hands-free ventilation during transport, rescues, and evacuations.
Hands-Free Ventilation
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Optional Nose Clip
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For the occasional case in which the retention shield does not fully occlude the nose, apply the included optional nose clip.
When using a hand grip, what do I do if the seal at the lips is leaking? If the seal is leaking, relax your grip slightly by opening your hand.
Then reapply the grip while pulling in a larger amount of the patient’s lips and cheeks towards the mask. This may require closing the mouth a little if it’s open too wide. This action increases the amount of tissue applied against the IOM flanges and stem to increase the sealing capability. The solution is not necessarily to increase the pressure applied.
FAQs
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When using the retention shield, what do I do if the seal is leaking? If leaking from the lips, using the Velcro fasteners, slightly increase equal
tension on both straps. If leaking from the nose, confirm proper placement of the shield’s notched
upper edge, compressed up into the nostrils. Then, using the Velcro fastener, slightly increase tension on the upper strap. If the leak continues, apply the provided nose clip.
FAQs
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What do I do if my hand grip is slipping? If the patient’s face is slippery due to emesis/oil, use the finger/fingers
under the jaw line to help anchor the grip, and apply a small amount of additional downward pressure over the lips and nose.
FAQs
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Are there different IOM sizes? No, the IOM will normally accommodate all adults, and children in whom
the mask comfortably fits in their closed mouths. In children with smaller mouths the CPR IOM may be applied to the outside of their lips as demonstrated in the NuMask CPR Training Presentation. The OPA comes in both Large and Medium. The Large should accommodate most adults. A smaller pediatric/newborn size IOM and OPA is in development.
FAQs
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Do I need to use the OPA with every patient? No, the OPA is necessary if the patient’s airway cannot be maintained
with head extension/chin lift and jaw thrust. The OPA is inserted first, followed by the IOM as described in the training materials.
FAQs
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Can I use other OPAs? No, the intraoral placement of the IOM precludes proper placement of
other OPAs. An IOM-compatible NuMask OPA must be used.
How do I size the OPA? Proper sizing is determined by holding the OPA up to the patient’s cheek;
tabs flush with the front teeth, and the tip at the angle of the jaw.
FAQs
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Can I trim the OPA to size? Yes. The OPA is made of an innovative, flexible material that allows
providers to trim to size.
How is the OPA inserted? The OPA is inserted in one of the two standard methods. A tongue blade
may be used or the OPA is inserted in an inverted manner and then rotated 180 degrees. As with all OPAs make sure the tongue is not pushed back, potentially causing an obstruction.
FAQs
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Will the OPA fall back into the throat? The proximal end of the OPA will reside in front of the teeth. Due to the
flexible nature of the OPA, there is a tendency for it to spring out of the mouth. This decreases the likelihood of its lodging in the throat. Proper airway management requires accurate placement of the OPA/IOM, just as with all other medical equipment.
FAQs
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How do I detect secretions, emesis, or blood when using the IOM? The IOM is transparent with a highly polished finish at the base of the
stem to allow for easy visualization of the OPA and any secretions or bodily fluids. It should be promptly removed if there is any risk of aspiration.
FAQs
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What do I do if the patient vomits with the IOM in place? Remove the IOM, suction/clear emesis from the airway, wipe emesis
from the patient’s face, then replace the IOM and resume ventilation. If the face is slippery due to emesis, use the finger/fingers under the jaw line to help anchor the grip, and apply a small amount of additional downward pressure to the lips and nose.
What do I do if the patient vomits while wearing the Retention Shield? Remove the retention shield and IOM by releasing the Velcro fasteners
and pulling away on the mask stem or retention shield itself. Assure emesis is cleared appropriately.
FAQs
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Do I need to be at the head of the patient to ventilate with the IOM? No, the various NuMask grips allow ventilation in multiple provider and
patient positions, including: lateral, upright, and prone (as may be necessary during rescues, evacuations, transports, and OR cases). Allowing a provider to be positioned at the side of the patient provides more room for advanced airway management to be concurrently implemented at the head of the patient.
FAQs
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Does it require two providers to ventilate with the IOM? No, due to the leak-free seal with a one-handed grip, a single provider
should be able to ventilate and seal with ease.
Can I use the CPR IOM on a child or infant victim? Yes, the CPR IOM rests on the outside of the victim’s lips with the
victim’s mouth open and the standard CPR grip is applied.
FAQs
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Do I need to be in one particular position to ventilate with the CPR IOM? No, the characteristics of the CPR IOM allow for ventilation in multiple
rescuer and victim positions, including victims on their sides or upright. The various NuMask grips allow the rescuer to be comfortably positioned at either the head of the victim or at the side, depending on the situation and grip used.
Can the CPR IOM be used with a bag valve resuscitator? Yes, the standard bag valve resuscitator fitting will connect directly to either
the CPR IOM valve, or to the IOM with valve removed.
FAQs
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What is the ideal single-rescuer position when using the CPR IOM? For single-rescuer CPR, the side-of-victim position is ideal because there is
no need to reposition between compressions and rescue breaths. The IOM should be left in place during compressions to further speed transition between compressions and rescue breaths.
FAQs
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What are the ideal 2-rescuer positions when using the CPR IOM? For 2-rescuer CPR, the side-of-victim position is ideal for both rescuers
(on opposite sides of victim) because there is no need to reposition when changing compressor role. The IOM should be left in place throughout CPR to further speed the transitions.
FAQs
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Can I use the IOM and OPA in patients with no teeth or dentures? Yes, the IOM and OPA can still be used as effectively as in victims with
teeth. The seal may be enhanced by pulling back gently on the IOM while applying the grip. If there is no significant alveolar ridge, care should be taken to assure proper OPA positioning is maintained.
Can the IOM and OPA be used in those with dentures? Yes, it is best to leave them in place if they are securely affixed, and the
IOM and OPA can be inserted as usual. If dentures are loose, they should be removed first.
FAQs
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Do I ventilate the patient the same way I did before NuMask was invented? Yes, but due to the increased seal, there is no need to try and overcome
leaks inherent in the older mask styles. This is a very important issue. Avoid rapid harsh ventilations, which can overcome the esophageal opening pressures and lead to gastric distention. Instead, focus on smooth, rhythmic ventilation – which is crucial for optimal results.
FAQs
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Can the IOM be used in lieu of intubation? The IOM is not a definitive airway device and is not designed to replace the
ETT when a secured definitive airway is indicated. There are circumstances where the IOM can be used for extended periods. As always, the patient must be appropriately monitored and ventilated. To avoid gastric insufflation and provide appropriate ventilation, attention must be paid to proper bagging technique.
FAQs
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Can the IOM and OPA cause any injuries, and if so, what should I do? Both the IOM and OPA are made of soft, pliable material without sharp
edges but care must still be used with insertion and use. If injuries occur they must be reported via your institutional mechanism to our QI/QC department.
FAQs
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How can I help reduce my patient’s apprehension to CPAP/BiPAP or preoxygenation? Initially coaching patients to insert and hold the IOM themselves, while
breathing on CPAP/BiPAP or oxygen (prior to placing the retention shield), allows them a calming feeling of control.
FAQs
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Can the IOM be used in the OR? Yes, the IOM is compatible with all standard respiratory fittings.
Will the IOM fit those with underbites? Yes, the IOM can accommodate patients with marked underbites
by inverting the mask prior to insertion.
FAQs
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Can the IOM/OPA, CPR IOM, and Retention Shield be used in patients with latex allergies? Yes, the product line does not contain latex.
Are the IOM/OPA, CPR IOM, or Retention Shield reusable? No, the products are one-time use disposable devices. They need to be
properly disposed of after use or after being opened. The materials are NOT designed to tolerate an autoclave or chemical sterilization.
FAQs
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For more information, please contact us at:
NuMask, Inc. | 6320 Canoga Ave, Ste 1500Woodland Hills | CA, 91367
Phone | 866-NuMask1 (866.686.2751) Fax | 818.227.5099 E-Mail | [email protected] Web | www.numask.com
You may contact us 24 hours a day.
Contact Information
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