Therapy

Give oxygen ^a

Give salbutamol ^d and ipratropium ^b  

Give morphine in small doses if markedly dyspnoeic ^a

Give a loop diuretic ^a intravenously ^d (e.g. frusemide 40-80 mg)

• Ask patients to remain in bed afterwards. ^b  
• For large doses, consider using an infusion ^d

Pulmonary oedema

Give an ACE inhibitor ^a  

Give patients with respiratory failure continuous positive airway pressure (CPAP) ^a

Consider inotropic support if there is hypotension ^d

There is no clear benefit from balloon counterpulsation ^d 
Avoid milrinone ^a

Resistant cases

• Add a thiazide ^c  
• Give erythropoeitin and iron to patients with anaemia ^a

Consider

• transplantation ^a
• left ventricular assist devices ^a