A 51-year-old female presents with sudden onset of difficulty breathing. She is conscious and able to speak in complete sentences. Her respirations are 22 breaths/min and regular. Which action is most appropriate?

• A. Administer oxygen via a nonrebreathing mask.
• B. Perform a secondary assessment and then begin treatment.
• C. Insert a nasal airway in case her mental status decreases.
• D. Assist her ventilations with a bag-valve mask.

Answer: (A)

When someone is in respiratory distress but still conscious and able to speak, the immediate goal is to optimize oxygenation while keeping the airway protected. Providing high-concentration oxygen is the priority because hypoxemia can develop quickly in sudden dyspnea, and the patient can benefit from rapid oxygen delivery without needing airway devices yet. A nonrebreathing mask delivers a high FiO2, making it the appropriate choice to improve oxygen levels now.

Since she is alert and breathing adequately (speaking in full sentences, regular rate), there’s no need for an airway adjunct like a nasal airway, which is more suited to patients with reduced mental status or compromised airway protection. A secondary assessment and other treatments are important, but delaying oxygen delivery could worsen hypoxia. Bag-valve-mask ventilation is reserved for patients who are not breathing adequately or who have poor ventilation, which isn’t the current situation.