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.