So, yes airway airway airway. If he is at 97% on 15L non rebreather, doesn't that mean his airway is holding up fine? QUOTE]
This is a dangerous assumption to make. This is exactly the type of patient that gets put on a stretcher in the hallway because he stinks and is drunk and when you go back in an hour to see him he is dead.
Remember, saturation is not a good indicator of resp effort. A patient can be apnec for 2 minutes before having a drop in saturation, by the time he drops its pretty late. I have seen this with my own two eyes in the PACU, the sat is fine but the patient is not breathing at all or taking breaths so shallow that he has no breath sounds because he is not moving air.
The nasal airway is in place to keep his airway open until arrival at the hospital. This patient would have to be closely watched if the doctor decided not to intubate on arrival. Depending on the doctor, you may have some that would intubate right away and others that would just watch him closely and see if he improves.
Personally, if the patient did not have active shingles I would not put him in an isolation room where I can't see him.