A patient with emphysema presents with shortness of breath. He is placed on 15 L/min oxygen and subsequently becomes unconscious and not breathing, though a strong carotid pulse is present. What should you do first?

• A. Continue oxygen at 15 L/min
• B. Take off the oxygen
• C. Begin CPR immediately
• D. Switch to room air and provide rescue breaths

Answer: (B)

When a patient with emphysema stops breathing but still has a strong carotid pulse, the priority is to restore ventilation, not start chest compressions. You should open the airway and begin rescue breaths using a bag‑valve mask connected to oxygen. Deliver about one breath every 5–6 seconds (roughly 10–12 breaths per minute) while you reassess. In COPD, avoid letting oxygen be withheld entirely, but titrate to a target oxygen saturation (roughly 88–92%) to prevent CO2 retention while ensuring adequate oxygenation. Do not remove the oxygen completely; you’re trying to re‑establish ventilation while maintaining safe oxygen levels. If the pulse were to disappear, then you would start CPR.