For this Protocol Review, we will be looking at Adult Respiratory Distress.
This is a general protocol for undifferentiated respiratory distress; identifiable causes including airway obstruction and anaphylaxis are addressed in different protocols.
All EMS providers, from first responders to paramedics, are trained to collect a set of vital signs and can initiate supplemental oxygen for identified vital sign abnormalities.
BLS providers in NYC may initiate continuous positive airway pressure (CPAP) for persistent respiratory distress; this is not just an ALS skill.
ALS providers have a host of interventions written into their protocols including:
- CPAP
- Endotracheal Intubation
- Needle decompression for suspected pneumothorax
- Cardiac monitoring, ECG, and interventions related to any relevant cardiac pathway
- Sublingual and/or IV Nitroglycerin for suspected Acute Cardiogenic Pulmonary Edema
Medical Control Option:
Furosemide may be given at our discretion, 20-80mg IV
Prehospital furosemide has been the topic of some controversy, especially when administered without physician oversight. The reasons for this are that heart failure can be a difficult diagnosis to make in the prehospital setting without labs or imaging, and with sometimes limited medical history. In one study (Jaronik et al, 2005) retroactively analyzing the appropriateness of EMS administered furosemide, it was given appropriately for heart failure 58% of the time, was identified to be inappropriate but benign in 25% of administrations, and inappropriate and potentially harmful in 17% of administrations. When deciding whether to approve this adjunct, just consider: will this significantly alter the course of this patient’s care, or can it wait until they are in the ED? And approve at your discretion.