Standard initial management in Heart failure

• Supplemental Oxygen
• Endotracheal intubation with mechanical ventilation is indicated if instability
• Cardiac monitoring
• pulse oximetry
• 12-lead electrocardiogram
• Intravenous access
• Frequent vital sign assessments.
• Chest radiography
• Complete blood cell count
• Electrolytes
• BNP level
• Cardiac markers

Acute Pulmonary Edema

• Intravenous diuretics, diuresis can begin 10 to 15 min after intravenous furosemide. If urine output is inadequate in 20 to 30 min, the diuretic dose is increased and repeated.
• Furosemide Dose  
            No prior use: 40 mg IVP
            If prior use: Double last 24-h usage (range, 80–180 mg)
            If no effect by 20–30 mins: re-double dose