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Medical

RESPIRATORY DISTRESS

Signs and Symptoms: Differential Diagnosis:
• Shortness of Breath • Asthma
• Pursed Lip Breathing • Anaphylaxis/Allergy
• Decreased Ability to Speak • Aspiration
• Tachypnea/Hyperpnea • COPD
• Wheezing/Rhonchi/Rales • Pleural Effusion
• Use Accessory Muscles • Pneumonia
• Fever/Cough • Congestive Heart Failure/Cardiac
• Tachycardia • Pulmonary Embolus
• Absent Breath Sounds • Pneumothorax
(Emergent) • Pericardial Tamponade
• Hyperventilation
• Toxic Inhalation (e.g., Cyanide, CO)
Universal Patient Care Guideline
AIRWAY Guideline
Consider: Indications of: Position to
Early establishment of YES Respiratory Insufficiency NO Patient Comfort Monitor O2 Sat
Advanced Airway! (*See Pearls)
Rales / Signs of CHF Wheezes Stridor
100% O2 via NRB View for Obstruction:
PPV/NIPPV (CPAP/BiPAP) (jaw-thrust for c-spine injury)
100% O2 via NRB
Albuterol 90mcg MDI • Sweep & Suction prn
2 puffs or 5mg neb 100% O2 via NRB
NTG SL 0.4mg q5min if SBP >90 Consider Epinephrine 1:1,000
0.3mg IM (EpiPen) O2 Sat <90% or respiratory
status continues to deteriorate:
IV/IO Guideline Consider: AIRWAY Guideline
If Failing to Improve, Consider IV / IO Guideline ALLERGIC
REACTION
Furosemide 60-80mg IV (Place • Methylprednisolone 125mg IV
Foley if possible) Consider: Albuterol 90mcg MDI
2 puffs or 5mg neb
• Magnesium Sulfate 2g IV
over 20min Consider Epinephrine 1:1,000
0.3mg IM (EpiPen)
Last resort: IV/IO Guideline
Ketamine 1mg/kg IV Bolus
(SLOW PUSH) Methylprednisolone 125mg IV
Pearls:
• Signs of respiratory insufficiency: Cyanosis, altered mental status/loss of consciousness, fatiguing, inability to speak, or inability
to maintain O2 sat >90% with supplemental O2.
• Albuterol can be administered with spacer or short (6”) section of ventilator tubing to increase delivery if patient unable to perform
action appropriately. No max dose of albuterol, repeat as needed for continued wheezing.
• Lack of abnormal breath sounds does not always signify improvement. As respiratory status worsens, there may be inadequate air
movement to produce these sounds.

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