Initial treatment of acute cardiogenic pulmonary oedema in the prehospital setting
The patient should sit as upright as possible during treatment for acute cardiogenic pulmonary oedema. Arrange for urgent ambulance transport to hospital.
In the ambulance or while waiting for the ambulance, start furosemide (frusemide) for acute cardiogenic pulmonary oedema. Use:
furosemide (frusemide) 20 to 80 mg intravenously or intramuscularly, repeated 20 minutes later if necessary furosemide (frusemide) furosemide (frusemide) furosemide (frusemide)
PLUS (if oxygen saturation measured by pulse oximetry [SpO2] is less than 92%)
high-flow oxygen (titrated to response) via an oxygen mask fitted with a reservoir to maximise inspired oxygen delivery.
Patients who are taking oral furosemide may need a higher dose of parenteral furosemide.
If clinical response to oxygen and furosemide therapy for acute cardiogenic pulmonary oedema is inadequate, consider adding glyceryl trinitrate. Use nitrates with caution in patients with systolic blood pressure below 100 mmHg, symptomatic hypotension or signs of poor perfusion. If glyceryl trinitrate is appropriate, use:
1glyceryl trinitrate spray 400 to 800 micrograms sublingually; repeat every 5 minutes up to a total of 3 sprays (1200 micrograms) glyceryl trinitrate glyceryl trinitrate glyceryl trinitrate
OR
1glyceryl trinitrate tablet 300 to 600 micrograms sublingually; repeat the dose every 5 minutes up to a total of 3 doses (1800 micrograms). glyceryl trinitrate glyceryl trinitrate glyceryl trinitrate