You and your partner are working an ALS rig for an urban service, when you are dispatched to a private residence for a mid-50s YOF c/o dyspnea. The pt is wrapped up in blankets on the bed, and states that she was recently (within the last week) diagnosed with bronchitis. The pt is restless and has a harsh, productive cough. The pt also states that despite frequent use of her inhaler, she is not getting any relief from the shortness of breath. Pt is asking repetitive questions, and only follows commands after several attempts at instructing her.


  • Pt is a GCS of 13
  • Skin is hot, ashen, and moist
  • Weak/regular/rapid radial pulses
  • Resp appear to be elevated @28bpm
    • Audible rhonchi w/dark phlegm produced
    • Expiratory wheeze noted in the anterior fields
    • Pt demands to sit up and is very restless
  • No obvious trauma noted


  • SpO2: 92% R/A
  • RR: 28/mildly labored
  • H/R: 136/regular; narrow complex ECG w/no ectopy or ST abnormality
  • B/P: 88/50
  • BGL: 186
  • Tympanic Temp: 101.9F


  • Where do you start?
  • What are some possible concerns you have?
  • Specific facility you would transport to?
  • Does your treatment change depending on whether or not you work in an urban v. rural setting?

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