FIELD REFERENCE
Full criteria & treatment guidance
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.
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 CHF pattern, including a respiratory rate 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.
VISUAL FIELD REFERENCE
Respiratory distress: distinguish the presenting pattern
Adult / adolescent · ALS
Pattern recognition checkpoints. Open the corresponding treatment section for the complete regimen.
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.
Rales / suspected CHF
Obtain a 12-lead; suspected acute MI requires base contact for CVRC destination. Check nitroglycerin medication exclusions.
Stridor
For stridor, position comfortably and provide ALS transport; if allergy is suspected, use the anaphylaxis order.
- Prepare to assist ventilation when breathing is inadequate; do not rely on a saturation reading alone in severe COPD distress.
- CPAP is not appropriate for every patient in respiratory distress; review its airway, BP, trauma, and age exclusions.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. SO-M-035 · PR-120 · SO-C-015
UNDERSTAND THE CARE
Why a saturation number cannot replace a breathing assessment
Oxygenation, ventilation and the work of breathing are related observations but do not answer the same question. The local guide requires assessment of air movement, effort, mental status and perfusion alongside SpO₂. A patient with inadequate breathing needs consideration of assisted ventilation even while oxygen is being delivered.
Applying the guidance
Identify the clinical pattern before copying treatment from another pathway. Suspected fluid-overloaded CHF differs from volume depletion, and nitroglycerin pressure criteria belong to the specific respiratory branch. Stridor with allergic features directs attention to anaphylaxis. After treatment, compare effort, air movement, pressure and consciousness, not just the oxygen saturation.
Putting it together
Teaching example: saturation improves on oxygen but the patient becomes drowsy with inadequate effort. Reassess ventilatory support rather than assuming that the improved oxygen reading completes stabilization.
Diagram text & teaching checkpoints
- Breathing
- Effort and air movement.
- Oxygenation
- SpO₂ and response to oxygen.
- Pattern
- Wheeze, CHF or upper-airway concern.
- Reassessment
- Ventilation, pressure and mental status.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
Describe what “breathing better” actually means
After a treatment, compare the same observations you used before it: effort, air movement, oxygenation, mental status and circulation. Saying that the patient is “better after a nebulizer” does not tell the next clinician whether ventilation improved, whether the treatment was tolerated or whether the original clinical pattern still fits.
For example, a patient may become more comfortable, speak more easily and move air better while remaining tachypneic. That is a different report from a patient who becomes quiet because effort and interaction are diminishing. Record the observed changes rather than using quieter wheeze or a lower respiratory rate as the entire endpoint.
Keep treatment permissions tied to the presenting pattern. The wheeze pathway, suspected pulmonary-edema pathway and stridor pathway are not interchangeable. If CPAP is considered, open its separate eligibility and exclusion checks; listing it beside both bronchospasm and pulmonary edema does not make it appropriate for every breathing complaint. New deterioration or a need for further stabilization orders should be communicated with the current findings and the treatments already attempted.