›Immediate stabilization
›Escalate to resuscitation bay if severe hypoxemia or declining mental status
›Continuous monitoring
›SpO2
›Cardiac monitor
›Blood pressure cycling
›IV access
›Two large bore peripheral IV if unstable
›Intraosseous if no access and crashing
›Oxygen strategy
›Nasal cannula to target SpO2 92 to 96 percent
›COPD hypercapnia risk target SpO2 88 to 92 percent
›Airway protection
›If GCS less than 8 or inability to clear secretions, prepare for intubation
›Suction ready and positioned
Respiratory support escalation
›Oxygen and ventilation escalation
›High flow nasal cannula if persistent hypoxemia
›NIV with caution
›Avoid if ongoing emesis
›Avoid if unable to protect airway
›Intubation triggers
›Refractory hypoxemia
›Rising PaCO2 with acidosis
›Exhaustion or altered mental status
Antibiotics and when not to
›Antimicrobials decision logic
›Aspiration pneumonitis without infection features
›Supportive care
›No prophylactic antibiotics
›Aspiration pneumonia suspected
›Treat similar to CAP or HAP based on setting
›Anaerobic coverage not routine unless abscess or empyema
›Example adult regimens local protocol dependent
›CAP pattern without MRSA or Pseudomonas risks
›Ampicillin sulbactam IV 3 g every 6 hours
›Ceftriaxone IV 2 g daily plus azithromycin IV or PO 500 mg daily
›Severe beta lactam allergy
›Levofloxacin IV or PO 750 mg daily
›Add clindamycin only if abscess or empyema concern
›MRSA risk factors
›Add vancomycin IV 15 to 20 mg per kg every 8 to 12 hours
›Or linezolid IV or PO 600 mg every 12 hours
›Pseudomonas risk factors
›Piperacillin tazobactam IV 4.5 g every 6 hours
›Or cefepime IV 2 g every 8 hours
Supportive care and adjuncts
›Symptom and complication control
›Bronchodilator trial for wheeze
›Salbutamol inhaled 4 to 8 puffs via MDI with spacer
›Or nebulized salbutamol 5 mg
›Antipyretic
›Acetaminophen PO or PR 650 to 1000 mg every 6 hours
›Maximum 4000 mg per day adult
›Fluids for hypoperfusion
›Balanced crystalloid 10 to 20 mL per kg bolus with reassessment
›Dynamic reassessment preferred
›Reassessment timing
›Recheck vitals and work of breathing every 15 to 30 minutes until stable
›Repeat lung exam after interventions
›Repeat blood gas if ventilation concern and clinical worsening
›Repeat imaging if deterioration or complication concern
›Consultation triggers
›ICU if escalating oxygen support or shock physiology
›Anesthesia or airway team if difficult airway risk
›Pulmonology for bronchoscopy consideration
›Speech language pathology for dysphagia and aspiration prevention
›Toxicology if caustic or hydrocarbon exposure