An alert and distressed 72-year-old male with a history of congestive heart failure is in severe respiratory distress, breathing 28 to 32 times a minute. His airway is patent, respirations labored, and skin diaphoretic with a weak and rapid radial pulse. Vital signs are: pulse 136, respirations 28, blood pressure 202/110 mmHg, and SpO₂ 83%. Cyanosis is evident in the fingertips. The best treatment of his breathing would be:

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The best treatment for this patient's severe respiratory distress would be Continuous Positive Airway Pressure (CPAP). CPAP helps to keep the airway open and supports the patient's breathing, which is especially important for patients with congestive heart failure who may have fluid buildup in their lungs. Albuterol MDI would be more appropriate for a patient with bronchospasm or asthma. High-concentration oxygen with a nonrebreather would provide adequate oxygenation, but would not address the patient's labored breathing. Nasal airway with high-concentration O₂ may help to maintain an open airway, but would not offer the same level of support as CPAP.

An Alert and Distressed 72-Year-Old Male with a History of Congestive