Acute respiratory distress — severe dyspnea, SpO₂ persistently below the ordered threshold unresponsive to intervention, cyanosis, or new accessory-muscle use — emergency evaluation/transfer.

Tracheostomy obstruction/decannulation — inability to pass a suction catheter, no airflow, or a dislodged tube — emergency airway management per protocol and transfer.

New stridor or suspected aspiration with color change, congestion, fever, or hypoxia — assess, position, suction, and escalate (aspiration-pneumonia risk).

Suspected pulmonary embolism — sudden dyspnea, pleuritic pain, tachycardia, hypoxia (especially post-op or on immobility) — escalate/transfer.