What should you do if, during assisted ventilation with a bag-valve-mask, there is poor chest rise?

• A. Endotracheal intubation immediately.
• B. Stop ventilation.
• C. Reposition the airway, improve mask seal, and reassess.
• D. Increase ventilation rate to 40 breaths per minute.

Answer: (C)

When air isn’t moving effectively into the lungs during bag-valve-mask ventilation, the priority is to fix how the air is entering the airway. Poor chest rise usually means there’s either a lapse in the airway position or a leak in the mask seal. Reposition the airway to open the passage (use a jaw-thrust or head-tilt/chin-lift as appropriate for the patient), and improve the mask seal so air can be directed into the lungs without leaking around the edges. After adjusting, reassess chest rise, and also check breath sounds.

If chest rise improves, continue bagging with proper rate and volume and monitor closely. If it does not improve, look for airway obstruction (such as the tongue or secretions) and clear with suction, then consider placing an airway adjunct or proceeding to advanced airway management as trained. The other options don’t address the underlying issue: ending ventilation stops oxygen delivery, and simply increasing the rate without fixing the seal or airway position can worsen ventilation and cause other complications.