An unconscious patient is being ventilated with a bag-valve mask, but there is no chest rise. What is the next recommended action?

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When bag-valve mask ventilation shows no chest rise, the airway isn’t being opened or the seal isn’t allowing air to enter the lungs. The most effective first step is to reposition the airway to realign the airway axes and improve the mask seal. In an unconscious patient, use a jaw-thrust or head-tilt–chin-lift to open the airway; if spinal injury is possible, a jaw-thrust is preferred to avoid neck movement. This adjustment often restores chest rise by clearing obstruction and improving air passage.

After repositioning, recheck for chest rise and ensure the mask seal is good and the patient is receiving adequate oxygen. If chest rise still isn’t achieved, address potential obstruction (suction if needed), consider an airway adjunct such as an oropharyngeal or nasopharyngeal airway if appropriate, and escalate to an advanced airway (supraglottic device or endotracheal intubation) if ventilation remains inadequate.