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What should be your first action if a flow-resistor expiratory airway pressure (PEP) device does not generate pressure during expiration?

  1. Replace the device

  2. Recheck and tighten all connections

  3. Adjust the patient’s position

  4. Change the tubing

The correct answer is: Recheck and tighten all connections

When a flow-resistor expiratory airway pressure (PEP) device fails to generate pressure during expiration, the first action should be to recheck and tighten all connections. This is because inadequate pressure generation can often be attributed to loose or poorly connected components. Ensuring that all connections are secure is a straightforward and effective troubleshooting step. If the connections are not tight, air can leak from the system, preventing the device from creating the necessary resistance and pressure during expiration, thus rendering it ineffective. By addressing this potential issue first, the clinician can eliminate a common and easily correctable problem before considering more drastic actions, such as replacing the device or changing the tubing.