You are called for respiratory distress. you arrive to find a male caox4 complaining of breathing problems. he has chronic obstructive pulmonary disease and congestive heart failure (chf), states he feels like he is drowning, and has waited too long to call 911. his vitals are as follows: bp 202/108, spo2 78% room air, rr 58 and shallow, pulse of 126 strong and regular, sinus tach on the monitor, and etco2 of 24mmhg with a shark fin waveform. he is extremely fatigued and his respiratory rate is beginning to slow as you get him into your ambulance. why is cpap not an option for this patient?