Ketones and high BG, should I worry?

My boyfriend is a type 1 diabetic, with an insulin pump. He has recently become ill and has vomited twice in perhaps 12 hours. He has moderate ketones in his urine and a BG of 290. He does not have a temp, but does seem to have labored breathing as he sleeps (right now). I don't smell sweet or acetone on his breath. Should I be concerned about ketoacidosis? Should we wait and check his levels (BG and ketones) in an hour and if they are still elevated, take him to the ER? He is uninsured and rather reluctant to go to the ER, but I will make him if it's life threatening.