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Vent Bag 1

Emergency Departments

Main Pocket

Ped/Adult single Limb wye ventilator circuits x2 *

Yes
No

Ventilator *

Yes
No

BVM kit *

Yes
No

Infant/Ped single limb wye ventilator circuit *

Yes
No

Oxygen Bottle w/ regulator *

Yes
No

Power Cord *

Yes
No

Left Side Inner pocket

Viral Bacterial Filter x2 *

Yes
No

ET SPO2 sampling line x2 *

Yes
No

SPO2 sticky probe *

Yes
No

Top Left Pocket

Small child mask *

Yes
No

Infant mask *

Yes
No

Blue mask harness *

Yes
No

Front Pocket

Oxygen adapter *

Yes
No

Ventilator setting sheet *

Yes
No

Oxygen Hose *

Yes
No

Comments

Name *

First

Last

Date / Time *

Date

Time

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