Stop & reassess

Remove CPAP for nausea/vomiting, oral/nasal bleeding, intolerance, or systolic BP below 90. PR-120 lists this removal threshold without a pediatric exception, even though its pediatric entry contraindication is below 80.
Escalate airway/ventilatory support if arrest, agonal respirations, or hypoventilation develops. Watch for gastric distention and aspiration.

BLS and ALS use

SO-B-001 authorizes OCEMS-accredited EMTs to apply and monitor CPAP. BLS units can use it when equipped and providers are trained and authorized for the device.
For BLS providers, use particular caution and have ALS en route or already on scene. Monitor continuously and be prepared for deterioration requiring additional airway or ventilatory support.
Medication and advanced-airway steps must stay within the provider’s own scope. CPAP authorization alone does not authorize independent albuterol administration or advanced-airway placement.

PR-120 applies to patients age 8 and older with moderate–severe nontraumatic respiratory distress and at least one qualifying finding.
Qualifying findings include SpO₂ below 90% despite routine oxygen; respiratory rate above 26/min (above 30 in children) with SpO₂ below 95%; accessory-muscle use/retractions; wheeze, rales, or rhonchi not improving with routine therapy; or fatigue with decreasing breathing effort.

Do not use with altered consciousness or inability to protect the airway; inability to sit; respiratory arrest/agonal failure; cardiac arrest; nausea/vomiting; oral/nasal bleeding; suspected pneumothorax; penetrating chest trauma; facial trauma/abnormality; upper GI bleeding; or stomach surgery within the previous month, including lap-band surgery.
The entry contraindication is systolic BP below 90 in adults or below 80 in children, or other poor-perfusion signs.

Provide oxygen. Albuterol for wheezing requires separate authorization within your scope. Let the patient sit comfortably and explain what to expect.
Document baseline lung sounds and SpO₂. Assemble the device and connect oxygen.
Start at 5 cm H₂O. Apply a well-sealed mask and ETCO₂ monitoring; use inline albuterol only when appropriate and authorized within your scope.
Adults/adolescents: increase gradually to 7.5, then 10 cm H₂O as tolerated and clinically needed. Pediatric maximum: 5 cm H₂O.

Continuously observe the patient. Reassess/document lung sounds before treatment, after starting, and every 5 minutes.
Record initiation time, pressure, vital signs, and consciousness. Notify the receiving ERC early. If removed, document the time and reason.
A DNR order alone does not exclude CPAP; the source permits its use when otherwise appropriate.