Lesson 1Focused respiratory exam: breath sounds, work of breathing, accessory muscle use, pulse oximetry, end-tidal CO2 interpretation, and peak flow when feasibleProvides a structured respiratory exam for complex patients, including inspection, palpation, and auscultation. Emphasizes work of breathing, accessory muscle use, pulse oximetry, EtCO2 waveform interpretation, and peak flow when feasible and safe.
Assessing respiratory rate, pattern, and effortInspection for accessory muscle use and postureSystematic lung auscultation and key findingsPulse oximetry limits and artifact recognitionEtCO2 values and waveform interpretation in COPDUsing peak flow to gauge obstruction severityLesson 2Airway escalation: when to use BVM, supraglottic airway, or perform RSI—drug selections, preoxygenation, and rapid sequence technique in respiratory failureDetails when to escalate from basic airway maneuvers to BVM, supraglottic airway, or RSI in respiratory failure. Reviews preoxygenation, drug selection, dosing, and rapid sequence technique, with emphasis on COPD and overdose physiology.
Indicators for BVM support and optimizationChoosing and placing supraglottic airwaysWhen to proceed to RSI in respiratory failurePreoxygenation strategies in COPD and obesitySedative and paralytic choices and dosingPost‑intubation ventilation and confirmationLesson 3Rapid history and scene clues: medication lists, smoke/odor, witness accounts, and assessment of mental statusFocuses on obtaining a rapid, targeted history and using scene clues to identify COPD, overdose, or mixed pathology. Covers medication lists, pill bottles, odors, paraphernalia, witness accounts, and mental status to guide early treatment decisions.
Primary survey and immediate life threatsKey questions for bystanders and caregiversInterpreting medication lists and pill bottlesEnvironmental clues: smoke, chemicals, paraphernaliaAssessing baseline versus new mental status changeIntegrating scene clues into working diagnosisLesson 4Monitoring and transport considerations: ventilator vs spontaneous breathing, continuous capnography, and pre-notification of receiving facilityAddresses monitoring and transport planning for ventilated and spontaneously breathing patients. Discusses continuous capnography, ventilator versus BVM support, positioning, destination choice, and pre‑notification to prepare the receiving facility.
Continuous SpO2 and EtCO2 during transportManaging patients on transport ventilatorsWhen to use BVM versus spontaneous breathingPositioning and securing airway and tubingChoosing destination and level of receiving careEffective pre‑notification and handoff reportsLesson 5Naloxone use for suspected opioid overdose: dosing strategies, routes (IV/IM/IN), titration to avoid acute withdrawal, and monitoringReviews naloxone pharmacology, indications, and contraindications in suspected opioid overdose with respiratory depression. Covers IV, IM, and IN routes, dosing strategies, titration to adequate breathing, and monitoring for recurrence or withdrawal.
Recognizing opioid toxidrome in the fieldNaloxone mechanism, onset, and durationChoosing IV, IM, or IN route for naloxoneInitial dosing and careful titration strategiesManaging acute withdrawal and agitation risksPost‑reversal monitoring and transport needsLesson 6Differentiating COPD exacerbation, cardiogenic pulmonary edema, aspiration, and opioid/sedative overdose—key exam and device findingsDetails how to distinguish COPD exacerbation, cardiogenic pulmonary edema, aspiration, and opioid or sedative overdose. Emphasizes focused exam, lung sounds, mental status, and device data such as EtCO2, oximetry, and ECG findings.
Typical history and triggers in COPD exacerbationSigns of cardiogenic pulmonary edema in the fieldClues to aspiration and airway contaminationRecognizing opioid and sedative overdose patternsUsing lung sounds, EtCO2, and SpO2 to differentiateRole of ECG, blood pressure, and jugular veinsLesson 7Bronchodilator therapy: beta-agonists, anticholinergics, dosing, routes, and nebulizer vs MDI considerationsCovers bronchodilator options for COPD and asthma overlap in respiratory failure. Reviews beta‑agonists and anticholinergics, indications, contraindications, dosing, and routes, plus practical differences between nebulizers and MDIs with spacers.
Short‑acting beta‑agonists: agents and dosingAnticholinergic bronchodilators and combinationsNebulizer setup, flow rates, and timingMDI with spacer: technique and coachingAdverse effects and monitoring during treatmentWhen to repeat or escalate bronchodilator therapyLesson 8Oxygen and ventilation strategies: titration targets for COPD, indications for high-flow nasal cannula, NIV (CPAP/BiPAP) settings and contraindicationsCovers oxygen titration targets in COPD, selection of delivery devices, and indications for high‑flow nasal cannula and NIV. Reviews CPAP/BiPAP setup, initial settings, troubleshooting, and key contraindications in unstable patients.
SpO2 and PaO2 targets in COPD and CO2 retainersChoosing nasal cannula, mask, or Venturi devicesIndications and setup for high‑flow nasal cannulaInitiating CPAP and BiPAP: starting pressuresContraindications and complications of NIV useTroubleshooting mask leaks and patient intoleranceLesson 9Adjunct medical therapy: systemic corticosteroids (dosing and timing), magnesium, and diuretics for suspected cardiogenic pulmonary edemaExplores indications, dosing, and timing of systemic corticosteroids and magnesium in COPD or asthma overlap. Reviews diuretic selection and dosing for suspected cardiogenic pulmonary edema, including contraindications and monitoring needs.
Indications for systemic corticosteroids in COPDCommon steroid agents, doses, and onset timesUse of IV magnesium in severe bronchospasmRecognizing cardiogenic pulmonary edema in the fieldDiuretic choices, dosing, and contraindicationsMonitoring response and adverse medication effects
