2-12 RESPIRATORY DISTRESS

Considerations: airway obstruction, foreign body aspiration, chemical exposure, asthma, chronic obstructive pulmonary disease, emphysema, pulmonary edema, upper respiratory infection, bronchitis, pneumonia, pneumothorax, pulmonary embolus, bronchospasm with anaphylaxis. Note: Anxiety and hyperventilation, while possible, are not prehospital diagnoses. Respiratory distress will be treated with oxygen appropriate for the symptoms and delivery device applied. Any patient requiring ACLS care should have an ALS intercept if logistically possible.

EMR - Emergency Medical Responder

1. Begin initial medical care
2. Administer oxygen
3. Assist ventilations if RR < 8 or > 35
4. Administer artificial ventilation if respiratory arrest, respiratory fatigue or shallow respirations
5. Apply AED and follow AED protocol if PNB
6. Insert airway adjunct(s) & verify placement for respiratory arrest
7. Assess for hypotension/ shock (HR >130, cap refill > 2 seconds) & follow shock protocol

EMT – Emergency Medical Technician  Perform/Confirm All Above Interventions

1. Transport with close observation of respiratory status
2. If patient has history of CHF, pulmonary edema or heart disease, then assess for:
   1. Rales
   2. Peripheral edema
   3. JVD
   4. Orthopnea
3. Place in position of comfort & re-evaluate CPAP indications
4. Initiate CPAP protocol (if trained) as indicated
5. Request ALS intercept if
   1. Ventilations are being assisted
   2. Respiratory fatigue or shallow respirations
   3. Pulse oximetry < 90
   4. CPAP is initiated
6. Apply ECG monitor & run strip -
   1. If trained, if time allows and after all other interventions are completed
7. Perform 12-lead ECG (if trained) as indicated CONTACT MEDICAL CONTROL
8. For cases of obvious respiratory distress with clear breath sounds
   1. Administer high flow oxygen
   2. Administer patient’s prescribed hand-held, metered-dose inhaler as appropriate; 1 or 2 puffs if maximum dose not already taken prior to EMS arrival
   3. Administer albuterol (Ventolin) 2.5 mg with or without ipratropium (Atrovent) 500 mcg via nebulizer; May repeat once if no relief
9. For diminished breath sounds or wheezing
   1. Administer patient’s prescribed hand-held, metered-dose inhaler as appropriate; 1 or 2 puffs if maximum dose not already taken prior to EMS arrival
   2. Administer albuterol (Ventolin) 2.5 mg with or without ipratropium (Atrovent) 500 mcg via nebulizer; May repeat once if no relief
10. Provide CPAP with in-line nebulizer for continued respiratory distress after nebulizer treatment

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Start IV access if chest pain, CHF or respiratory failure
2. Administer Narcan 0.4mg IV/IN for narcotic overdose; May repeat up to max dose of 2 mg; Administer primarily to improve respiratory function CONTACT MEDICAL CONTROL
3. Initiate chest pain protocol for chest pain cases
4. For chest pain -OR- pulmonary edema with BP > 100
   1. Administer Nitroglycerin, 0.4 mg SL. May repeat X 3 doses if BP stays > 100 between doses

Intermediate & Paramedic  perform/ confirm all preceding interventions

1. Treat dysrhythmias primarily