Moving on from the pediatric respiratory distress/failure protocol to its adult counterpart this week, given that adults are just larger versions of kids (PEM colleagues – just kidding! please don’t hit me). Prehospital management of the adult in respiratory distress generally boils down to APE or asthma/COPD, with the occasional interesting obstructed airway case. The latter two instances are given their own distinct protocols to shine, so pulmonary edema gets to bulk of the attention here. As previously discussed with the older version of the protocols, we have the benefit if NYC of having BLS providers trained in the initiation of CPAP. ALS can continue NIPPV management but also obviously have advanced airway capabilities as needed. They’ll also administer nitroglycerin, either as a sublingual tablet or a spray, as SBP allows. As the OLMC doc, you’ll be answering the phone to authorize either a benzodiazepine to assist with anxiolysis or furosemide to initiate diuresis, as the situation demands.
As a bonus, I’ve also included protocol Appendix P, which provides EMTs and paramedics with inclusion and exclusion criteria for the initiation of CPAP. Interested in more EMS educational nuggets like this? Head to www.nycremsco.org or the North Side OLMC protocol binder for more!
Dave