Hi EM friends,
Time to take your breath away with another EMS protocol of the week. This week's focus will be on adult respiratory distress and how our prehospital counterparts initiate patient care prior to handing them off to us. A few months ago, we discussed the respiratory distress protocol for pediatric patients - a lot of overlap here except EMS providers have a couple more tricks up their sleeves when it comes to adults.
The prehospital approach to respiratory distress exists as a progression of care based on the provider's level of training. CFRs start with ABCs and monitoring vital signs. If needed, these providers can implement airway adjuncts and administer supplemental O2. All patients will be started off on a NRB unless the mask is not tolerated in which case O2 will be given via NC. At this level of training, CFRs can then address potential drug overdose.
BLS crews can address all of the above and will then transport these patients to the hospital. They can additionally request ALS backup while en route. If available, CPAP therapy can be utilized for patients with persistent distress.
If the on-scene team is ALS-trained, they can perform advanced airway management as necessary. From here, ALS providers will start cardiac monitoring, EKG interpretation, and establish IV access during transport. They can even assess and treat for a tension pneumothorax or administer Nitroglycerin for suspected flash pulmonary edema.
There is not a lot to be aware of from an OLMC standpoint, but providers have the option of authorizing Lasix to be given to patients that may benefit.
Also important to note, ALL patients who are received by EMS crews in respiratory arrest MUST receive ventilatory assistance unless an official DNR order and/or MOLST form is provided to the crew.
More words to read at www.nycremsco.org.
Best,
Zachary Kim, MD
PGY-2 Emergency Medicine