Dyspnea
BASIC LIFE SUPPORT/LALS
I. Primary Survey:
II. Reassure patient and place in position of comfort, loosen tight clothing.
III. Administer high flow oxygen. If patient has history of COPD administer
oxygen carefully, but never withhold oxygen if needed.
VI. Secondary Survey
V. Obtain and record vital signs according to Patient Assessment protocol
VI. Obtain and record pertinent medical history, medications, and allergies
VII. Criteria for determining respiratory insufficiency
A. Respiratory rate less than 10 or greater than 30 per minute.
B. Cyanosis.
C. Decreased level of consciousness.
D. Increased anxiety and restlessness.
E. Use of ancillary muscles.
VIII. Nebulizer protocol for respiratory distress with wheezing to lower airway
obstruction (inability to maintain normal ventilation and oxygenation). People
who are not breathing are not included for this protocol
A. Oxygen support starting with lower concentration 2-6 LPM by nasal
cannula increasing to 100% O2 BY non_rebreather mask for severe
shortness of breath.
B. Assist ventilation with BVM, if necessary.
C. Re-assess to make sure airway is not obtructed by a foreign body.
D. Place patient in comfortable position without compromising
patient care.
E. Monitor vital signs (heart rate, blood pressure, respirations) every
ten (10) minutes at a minimum until breathing improves. Utilize
pulse oximeter, if available.
F. Administer albuterol nebulizer as follows:
Adult: Albuterol 2.5 mg by nebulization (use 3ml of premix
solution)
Pediatric: Contact Medical Control for dose adjustment
G. Reassess patient.
NOTE: 1. The conscious, dyspneic patient may rapidly deteriorate.
2. Allergic reactions are frequently responsible for dyspneic
episodes a complete assessment including allergies is
extremely important.
3. COPD patients may react adversely to high flow oxygen.
Consider reducing the oxygen concentration if dyspnea is completely corrected with the administration of oxygen.
Dyspnea
ADVANCED LIFE SUPPORT
PRE-RADIO CONTACT
1. Continue BLS as indicated.
3. Monitor EKG.
4. Start an IV of NS at TKO rate.
5. Refer to Specific Respiratory Problems for approved protocol.
POST-RADIO CONTACT
1. Further orders per Medical Control
ADVANCED LIFE SUPPORT FOR SPECIFIC RESPIRATORY PROBLEMS
Acute Pulmonary Edema
PRE-RADIO CONTACT
1. Nitroglycerine 0.4 mg S.L. if BP is above 100 mmHg.
2. Furosemide 40 mg IVP slow.
POST-RADIO CONTACT
1. Furosemide 40-80 mg IVP slow.
2. Morphine 2-5 mg IVP up to 10 mg.
3. Albuterol 2.5 mg nebulized aerosol.
4. Further orders per Medical Control.
Dyspnea
Asthma
PRE-RADIO CONTACT
1. If wheezing present and patient has no history of cardiac administer
Albuterol 2.5 mg nebulized aerosol.
POST-RADIO CONTACT
1. Additional Albuterol 2.5 mg nebulized aerosol.
2. Epinephrine 0.3 mg 1:1,000 Sub Q.
3. Further orders per Medical Control.
Emphysema
PRE-RADIO CONTACT
1. If wheezing present administer Albuterol 2.5 mg nebulized aerosol.
POST-RADIO CONTACT
1. Further orders per Medical Control.