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Respiratory Distress

Inclusion Criteria: Patients complaining of shortness of breath or those who have labored respirations, dyspnea, wheezes, or rales. Treat patients suffering from respiratory distress caused by trauma using the Trauma guidelines and patients experiencing an allergic reaction using the Allergic Reaction guidelines.

Special Note: If fever is present with any respiratory signs or symptoms, or if the patient is coughing, sneezing, or generating airborne droplets, EMS personnel should wear a HEPA mask to avoid transmission of infection.

           Basic Level

  1. Assess and support ABCs.

  2. Position of comfort.

  3. Administer oxygen
    a.    As needed to maintain a SpO2 of at least 96%
    b.    For COPD with chronic hypoxia (home O2), titrate oxygen flow to maintain SpO2 of 88% - 92%.
            i. Observe for depressed ventilation.
            ii. If EtCO2 values rise in response to oxygen therapy, consider decreasing the concentration of supplemental oxygen.

  4. If the adult or pediatric patient is wheezing, administer albuterol 2.5 mg via nebulizer every 5 minutes up to 3 doses.

    Advanced Level

  5. All patients treated under this guideline must have continuous cardiac monitoring and capnography. If adysrhythmia develops, treat under its specific guideline.

  6. Establish IV access at a TKO rate or use a saline lock.

  7. Assess breath sounds

    a. Signs of CHF present (rales, peripheral edema, JVD, CHF history, end-stage renal disease)

    Adult

    • Nitroglycerin 0.4 mg SL (may administer without an IV if SBP greater than 110 mmHg) May repeat twice if SBP remains above 110 mmHg
    • If no significant improvement following nitro therapy, apply CPAP at 5 cm H2O pressure, if available.
          o In severe distress, medics may apply CPAP with the initial nitroglycerin therapy
          o If no improvement and the patient is tolerating CPAP, increase CPAP pressure to 10 cm H2O, if available
    • If wheezing is also present, BioTel may authorize albuterol
    • Obtain 12-Lead ECG and consult with BioTel, as needed

    Pediatric

    • Contact BioTel


    b. Wheezing

    Adult and Pediatric

    • Mild to moderate wheezing, administer nebulized
          o Albuterol 2.5 mg. If wheezing persists but the patient is
    • Improving, administer up to two additional albuterol doses
    • Not improving with the first albuterol dose, combine 2nd and 3rd albuterol doses with ipratropium 0.5 mg (ipratropium dose for infant less than 1 year is 0.25 mg).


    If no no significant improvement, following nebulizer therapy

    Adult

    • Apply CPAP at 5 cm H2O pressure, if available
          o If the distress does not improve and thepatient is tolerating CPAP, increase CPAP pressure to 10 cm H2O, if available

    Pediatric

    • Contact BioTel

    If no significant improvement following application of CPAP, simultaneously

    Adult

    • Administer methylprednisolone 60 mg – 125 mg IVP
    • Add 2 grams magnesium sulfate to 250 ml normal saline bag and infuse IV piggyback over 6 - 10 minutes
          o BioTel authorization required if dialysis patient
          o Avoid if history of COPD

    Pediatric

    • Contact BioTel


    If no response to nebulizers, CPAP or magnesium sulfate, administer

    Adult

    • 1:1,000 Epinephrine 0.3 - 0.5 mg SQ

    Pediatric

    • Contact BioTel

    c. For status asthmaticus, simultaneously

    Adult

    • Administer albuterol 2.5 mg mixed with ipratropium 0.5 mg every five minutes up to 3 doses
    • Apply CPAP at 5 cm H2O pressure, if available
          o If the distress does not improve and the patient is tolerating CPAP, increase CPAP pressure to 10 cm H2O
    • Administer methylprednisolone 60 mg – 125 mg IVP
    • Add 2 grams magnesium sulfate to 250 ml normal saline bag and infuse IV piggyback over 6 - 10 minutes.
          o BioTel authorization required if dialysis patient
          o Avoid if history of COPD

    Pediatric

    • Administer albuterol 2.5 mg mixed with ipratropium 0.5 mg every five minutes up to 3 doses (ipratropium dose for infant less than one year is 0.25 mg)
    • Contact BioTel

  8. For additional patient care considerations not covered under standing orders, consult BioTel.

 

 

 

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