Sit the patient upright
Oxygen
100% if no pre-existing lung disease
IV access and monitor ECG
Treat any arrhythmias, eg AF
Investigations whilst continuing treatment
Furosemide 40–80mg IV slowly
Larger doses required in renal failure
GTN spray 2 puff s SL or 2 ≈ 0.3mg tablets SL
Don’t give if systolic BP <90mmHg
Necessary investigations, examination, and history
If systolic BP ≥100mmHg, start a nitrate infusion,
eg isosorbide dinitrate 2–10mg/h IVI; keep systolic BP ≥90mmHg
If the patient is worsening:
• Further dose of furosemide 40–80mg
• Consider CPAP—improves ventilation by recruiting more alveoli, driving fl uid out
of alveolar spaces and into vasculature (get help before initiating!)
• Increase nitrate infusion if able to do so without dropping systolic BP <100
If systolic BP <100mmHg, treat as cardiogenic shock and refer to ICU
Oxygen
100% if no pre-existing lung disease
IV access and monitor ECG
Treat any arrhythmias, eg AF
Investigations whilst continuing treatment
Furosemide 40–80mg IV slowly
Larger doses required in renal failure
GTN spray 2 puff s SL or 2 ≈ 0.3mg tablets SL
Don’t give if systolic BP <90mmHg
Necessary investigations, examination, and history
If systolic BP ≥100mmHg, start a nitrate infusion,
eg isosorbide dinitrate 2–10mg/h IVI; keep systolic BP ≥90mmHg
If the patient is worsening:
• Further dose of furosemide 40–80mg
• Consider CPAP—improves ventilation by recruiting more alveoli, driving fl uid out
of alveolar spaces and into vasculature (get help before initiating!)
• Increase nitrate infusion if able to do so without dropping systolic BP <100
If systolic BP <100mmHg, treat as cardiogenic shock and refer to ICU
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