Respiratory distress guideline

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State of Wisconsin

Emergency Medical Services

Sample Medical Guidelines

Respiratory Distress


  • This protocol may apply to the following conditions:

    • Congestive Heart Failure (CHF)

    • Asthma/COPD

    • Allergy/Anaphylaxis

    • Pulmonary Infections

    • Spontaneous Pneumothorax

    • Upper Airway Obstruction

    • Anxiety and Hyperventilation Syndrome

    • Acute Coronary Syndromes


Assessment Findings

Chief Complaint

“Difficulty breathing,” “Shortness of breath”


Assess onset, duration, progression, subjective severity, possible triggering events, and response to treatments before EMS arrival.

Associated Symptoms/

Pertinent Negatives

Chest pain (what kind?), fever/chills, productive (of what?) cough


Check for possible exposure to known allergens. Check past history, medications and compliance for clues to cause of present illness.

Initial Exam

Check ABCs and correct immediately life-threatening problems.

Detailed Focused Exam

General Appearance: Tripod positioning; Purse-lipped breathing.

Neck: JVD?

Skin: Cool, moist and pale? Warm, dry and flushed? Urticaria? Cyanosis?

Respiratory Effort: Using accessory muscles, signs of fatigue; two-word sentences?

Lung Sounds: Wheezes, rales, rhonchi or stridor?

Heart Sounds: Rate, regularity.

Lower Extremities: Pitting edema of the ankles?

Neuro: ALOC, lethargy, somnolence?

Goals of Therapy

Improve oxygenation and ventilation, reduce the work of breathing, and treat underlying conditions.


BP, HR, RR, EKG, SpO2.


  • Routine Medical Care

  • Allow/assist the patient to assume a position of comfort (usually upright).

  • Oxygen as appropriate.

  • Support ventilation with BVM if apnea or hypopnea occurs.

  • Airway Adjuncts: If there is altered level of consciousness and loss of gag reflex, consider oropharyngeal or advanced airway, if approved.


  • Albuterol is indicated for Asthma and COPD, see Asthma & COPD Guidelines.

  • If patient is unresponsive with no gag reflex consider advanced airway in not already in place.

  • Consider CPAP, if approved.


  • IV/IO NS @ TKO, if approved.

  • Initiate a 500 ml bolus if hypotension or dehydration is present.


Contact Medical Control for the following:

  • Further orders

Origination August 2007

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