Initial treatment

Make sure the patient is sitting upright and then:

• oxygen - should be given in as high a concentration as practicable (100% if no pre-existing lung disease).
• digoxin - appropriate when there is atrial fibrillation with a fast ventricular rate - dose 0.75-1.25 mg PO, but can be iv very slowly if urgent.
• analgesia - if there is no COAD or liver failure then diamorphine 5mg iv slowly.
• details concerning the treatment of acute left ventricular failure in the menu option below.

Note, it may be difficult to discriminate bronchospasm, pneumonia and pulmonary oedema and, especially in elderly patients, all three may be present. If in doubt then treat all three simultaneously, e.g. salbutamol nebuliser, i.v. frusemide, diamorphine, ampicillin.