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RESPIRATORY DISTRESS 17.1

All Providers

  • Focused history and physical exam
  • Cardiac monitor, ETCO2, pulse oximetry, consider 12 lead EKG
  • Treatment Plan
    • Remove any obstructions in the airway
      • For choking infants: sequence of 5 back blows and 5 chest thrusts until item is dislodged
      • For choking adults and children: use abdominal thrust maneuver
    • Maintain airway, administer 10-15 lpm of oxygen via NRB
Key Considerations
  • Consider oral and nasal suctioning for infants and small children for secretions

Adult

EMT
  • CPAP at 5 cm H2O (oxygen at 10 lpm)
    • Consider when the patient is awake but needs assistance with oxygenation and ventilation such as in CHF/pulmonary edema or COPD
    • Explain the procedure to the patient
  • Refer to Allergic Reaction/Anaphylaxisprotocol if appropriate
  • If WHEEZING or STRIDOR is present
    • Nebulized Albuterol 2.5 mg (3 ml of 0.083%) q 10 minutes until symptoms improve may be given concomitantly with CPAP
  • Consider advanced airway
AEMT
  • Vascular access and fluid therapy per IV/IO Access and Fluid Therapy protocol
  • Albuterol/Ipratropium (DuoNeb) 3 ml via nebulizer
    • 3 mg albuterol/0.5 mg ipratropium
    • may repeat every 60 minutes if needed
    • may be given concomitantly with CPAP or BiPAP
  • CPAP/BiPAP
    • Consider when the patient is awake but needs assistance with oxygenation and ventilation such as in CHF/pulmonary edema or COPD
    • Explain the procedure to the patient
    • Apply the mask and begin the CPAP or BiPAP according to training instructions
      • CPAP: provide 5 cm H20 PEEP
      • BiPAP: provide 15 cm H20 IPAP, 5 cm H20 EPAP
    • Contact OLMC to discuss further setting and treatment after the initial setup
Paramedic

Pediatric
not to exceed adult dose

EMT
  • Allow the patient to remain in position of comfort and keep them as calm as possible
  • CPAP at 5 cm H2O (oxygen at 10 lpm)
    • Consider when the patient is awake but needs assistance with oxygenation and ventilation
  • Refer to Allergic Reaction/Anaphylaxisprotocol if appropriate
  • If WHEEZING or STRIDOR is present
    • Nebulized Albuterol 2.5 mg (3 ml of 0.083%) q 10 minutes until symptoms improve may be given concomitantly with CPAP
  • Consider advanced airway
AEMT
  • Vascular access and fluid therapy per IV/IO Access and Fluid Therapy protocol
  • Albuterol/Ipratropium (DuoNeb) 3 ml via nebulizer
    • 3 mg albuterol/0.5 mg ipratropium
    • may repeat every 60 minutes if needed
    • may be given concomitantly with CPAP or BiPAP
  • CPAP/BiPAP
    • ONLY use when the patient is one the machine at home. Maintain home settings and bring machine with patient. If unable to adequately ventilate return to BVM or advanced airway
  • If STRIDOR in infant less than 18 months of age
Paramedic