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I know that I am chiming in a little on the late side. With both the JVD, distal edema, and the crackles at the bases; I am driven toward a cardiogenic shock secondary to CHF. Pt is obviously not perfusing but HR is not bad.
1. 15 LPM via NRB to increase SpO2. I see this as being low due to the pulmonary edema. NRB should bring the 92 to at least 97.
2. The ECG to me looks as if he is throwing multiple PVCs or wide-complex tachycardia with pulse. Pt could crash at any minute due to the irritation of the cardiac muscle.
3. Major concern for me is to increase his pressure without increasing the workload on the heart so that he can start perfusing. For this I would probably start with two large bore NS (both so a fluid challenge can be done as well as have access for follow on meds). Because of the peripheral and pulmonary edema, the pt is intravascularly dry. Meds would be Levophed 8-12 mcg/min and titrate to maintain B/P or possibly Dobutamine.
4. Also consider a Foley to have better monitoring of I/O because once his kidneys start perfusing by increasing his B/P, he should start dumping some of the fluid from his edema.
5. As for the transport decision, I like the idea of trasporting by ground to a higher EOC that could further stabilize while air assets are getting spun up.
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