If there is no chest rise during bag-mask ventilation, what is the most appropriate next step?

• A. Reapply the mask, ensuring that a tight seal has been obtained
• B. Check the airway for obstruction and suction as needed
• C. Increase the bag ventilation rate
• D. Proceed to endotracheal intubation immediately

Answer: (A)

When bag-mask ventilation isn’t producing chest rise, the top priority is to ensure air is actually entering the lungs. The most effective next step is reapplying the mask with a tight seal, and adjusting the head/airway position as needed to optimize the seal and airway patency. A poor seal is the most common reason for no chest rise, and fixing the seal often restores effective ventilation. After achieving a good seal, reassess chest movement; if there’s still no chest rise, check for airway obstruction and suction as indicated. Simply increasing the bag rate won’t fix a seal or airway issue, and moving to intubation is not the immediate action unless ventilation remains ineffective after optimizing basic airway management.