Follow General Medical Protocol.
Mandatory interventions:
a. Cardiac monitoring
b. Oxygen
c. IV access
If WHEEZING OR a history of COPD/ASTHMA:
a. Administer ALBUTEROL/IPRATROPIUM SVN. This may be repeated every 20 minutes as needed enroute. If not significantly improved after first SVN, institute CPAP.
b. Administer DEXAMETHASONE (Decadron) 8 mg IV/IM
c. If patient has ASTHMA and is refractory to above treatment, administer MAGNESIUM SULFATE 50% 2 grams (mixed in 100 mL Normal Saline) infused over 20 minutes. (Note: There is NO evidence this is effective in COPD.)
d. If the patient is ASTHMATIC & condition worsens, administer EPINEPHRINE 1:1,000 0.3 mL IM.
If PULMONARY EDEMA (CHF) is suspected, check for the for the presence of rales or rhonchi.
If these are present AND the SBP is > 100 mm Hg:
a. Administer SL NITROGLYCERIN 1 tablet/spray every 5 - 10 minutes.
i. If SBP declines to 95 mm Hg, discontinue SL NTG.
b. Institute immediate CPAP ventilation.