# Respiratory distress

Use the wheeze, suspected CHF, or stridor pathway and reassess ventilation.

Population: Adult / adolescent. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See linked source for document revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/respiratory-distress/
Official source: [SO-M-035 — Respiratory Distress](https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-M-35%20Respiratory%2010-2025.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- CPAP is not appropriate for every patient in respiratory distress; review its airway, BP, trauma, and age exclusions.
- Differentiate suspected fluid-overloaded CHF from volume depletion before applying another condition’s fluid pathway.

## Source documents

- [SO-M-035 — Respiratory Distress](https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-M-35%20Respiratory%2010-2025.pdf)
- [PR-120 — Continuous Positive Airway Pressure (CPAP)](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/PR-120%20CPAP%2004-2026.pdf)
- [SO-C-015 — Chest Pain of Suspected Cardiac Origin or Suspected Angina Equivalent Symptoms](https://www.ochealthinfo.com/sites/hca/files/2021-07/SO-C-15%20updated.pdf)

## Immediate assessment & support

- Assess respiratory effort, lung sounds, oxygenation, perfusion, and mental status. Monitor cardiac rhythm.
- If SpO₂ is below 95%, provide high-flow mask oxygen or nasal cannula at 6 L/min as tolerated. The COPD branch lists 2 L/min by cannula initially, but explicitly says not to withhold oxygen in severe hypoxia/distress.
- Prepare to assist ventilation when breathing is inadequate; do not rely on a saturation reading alone in severe COPD distress.

## Wheeze / suspected bronchospasm

- Give albuterol 5 mg in 6 mL continuously by nebulizer, as tolerated.
- If there is no improvement, consider base contact for an IM epinephrine order. CPAP may be used when its separate criteria are met and no contraindication is present.

## Basilar rales, labored breathing & suspected CHF

- For the source’s CHF pattern (including RR above 20): if systolic BP is at least 100, give nitroglycerin 0.4 mg SL, repeating twice while BP stays at least 100.
- At systolic BP at least 150, the dose is 0.8 mg SL, repeating twice while BP stays at least 150. Reduce to 0.4 mg if pressure falls below 150 but remains above 100. Consider CPAP.
- Obtain a 12-lead; suspected acute MI requires base contact for CVRC destination. Check nitroglycerin medication exclusions.

## Stridor, reassessment & destination

- For stridor, position comfortably and provide ALS transport; if allergy is suspected, use the anaphylaxis order.
- Contact base for further stabilization orders, and provide ALS escort to an appropriate ERC. Recheck work of breathing, air movement, oxygenation, BP, and response throughout.