›Immediate stabilization workflow
›Airway readiness
›Suction and BVM available
›Difficult airway predictors
›Monitoring and access
›Continuous pulse oximetry
›Cardiac monitor
›Two IV lines if severe
›Oxygenation strategy
›Nasal cannula escalation
›Non rebreather escalation
›High flow nasal cannula if available
›Noninvasive ventilation if indicated
›Time critical bedside checks
›Glucose
›Temperature
›Focused lung auscultation
›POCUS if available
Oxygen and ventilation targets
›Targets and cautions
›SpO2 target 92 to 96 percent for most adults
›SpO2 target 88 to 92 percent in COPD with chronic CO2 retention risk
›Avoid excessive oxygen in chronic hypercapnia risk
›NIV indications and parameters
›COPD hypercapnic failure with acidosis
›Cardiogenic pulmonary edema
›Avoid NIV in inability to protect airway
›Avoid NIV in refractory vomiting
Intubation and RSI considerations
›Advanced airway pathway
›Indications
›Worsening hypercapnia with acidosis
›Persistent hypoxemia despite escalation
›Altered mental status with airway risk
›Exhaustion
›Preoxygenation
›High flow nasal cannula if available
›NIV preoxygenation if tolerated
›Peri intubation hypotension prevention
›Fluid bolus if hypovolemic pattern
›Vasopressor ready
›Induction examples
›Ketamine IV 1 to 2 mg per kg
›Etomidate IV 0.3 mg per kg
›Paralysis examples
›Rocuronium IV 1.2 mg per kg
›Succinylcholine IV 1.5 mg per kg
›Obstructive airway disease
›Albuterol nebulized
›Adult dose 2.5 to 5 mg
›Repeat dosing based on response
›Ipratropium nebulized
›Adult dose 0.5 mg
›Combine with albuterol for severe asthma or COPD
›Systemic corticosteroid
›Prednisone PO 50 mg
›Methylprednisolone IV 125 mg
›Magnesium sulfate IV for severe asthma
›Adult dose 2 g over 20 minutes
›Avoid in significant renal failure risk
›Cardiogenic pulmonary edema
›NIV early if tolerated
›CPAP pathway
›BiPAP pathway
›Nitroglycerin if hypertensive and no contraindication
›SL 0.4 mg every 5 minutes as needed
›IV infusion local protocol dependent
›Loop diuretic if volume overload pattern
›Furosemide IV 40 mg typical starting dose
›Higher dose if chronic diuretic use
›Pneumonia and sepsis
›Antibiotics local protocol dependent
›Timing within 1 hour in septic shock pathway
›Coverage based on risk factors and local resistance
›Fluids and vasopressors
›Crystalloid 30 mL per kg in shock local protocol dependent
›Norepinephrine first line vasopressor local protocol dependent
›Pulmonary embolism
›Anticoagulation if no contraindication and high suspicion
›Heparin infusion local protocol dependent
›Avoid anticoagulation in major bleeding risk
›Thrombolysis for massive PE with shock local protocol dependent
›Contraindications review
›Critical care and specialty consultation
›Anaphylaxis and angioedema
›Epinephrine IM
›Adult dose 0.3 to 0.5 mg of 1 mg per mL
›Repeat every 5 to 15 minutes if needed
›H1 antihistamine
›Diphenhydramine IV 25 to 50 mg
›Sedation risk
›Steroid adjunct
›Dexamethasone IV 10 mg
›Delayed onset
›Airway early if progressive swelling
›Difficult airway activation
›Surgical airway readiness
›Pneumothorax
›Tension physiology
›Immediate needle decompression
›Tube thoracostomy definitive
›Non tension
›Imaging confirmation pathway
›Chest tube criteria by size and symptoms
Monitoring and reassessment loop
›Reassessment cadence
›Every 5 to 15 minutes in unstable patients
›Work of breathing trend
›Oxygen requirement trend
›Lung exam trend
›Repeat gas if hypercapnia concern
›Consultation triggers
›ICU for impending failure
›Anesthesia for difficult airway
›Respiratory therapy for NIV
›Cardiology for suspected ACS or cardiogenic shock
›Pulmonary or critical care for severe asthma or COPD
›Surgery for airway obstruction or pneumothorax complications