During CPAP in severe respiratory distress, if heart rate increases and the patient becomes unresponsive, you should

• A. remove the CPAP device and ventilate him with a bag-mask device.
• B. decrease the amount of pressure that the CPAP device is delivering.
• C. remove the CPAP device and apply oxygen by nonrebreathing mask.
• D. increase the amount of pressure that the CPAP device is delivering.

Answer: (A)

When a patient on CPAP deteriorates to unresponsiveness with a rising heart rate, the priority is to protect the airway and provide effective ventilation with a bag-valve-mask device. CPAP relies on the patient’s ability to breathe spontaneously and to maintain airway reflexes. If the patient becomes unresponsive, these protections are lost, increasing the risk of airway obstruction and aspiration. Switching to bag-valve-mask ventilation allows you to actively ventilate with high-flow oxygen and monitor chest rise, while you manage the airway, suction as needed, and consider advanced airway assistance.

Lowering CPAP pressure would not address the problem of an unprotected airway or ensure adequate ventilation. A nonrebreathing mask can oxygenate but does not provide ventilation for an unresponsive patient. Increasing CPAP pressure could worsen hemodynamics and further compromise ventilation in a patient who cannot protect their airway.