Treatment of acute pulmonary edema

Mnemonic:  'LMNOP'

Lasix (furosemide) intravenous (IV), one to two times the patient's usual dose, or 40 mg if the patient does not usually take the drug.

Morphine sulfate. Initial dose, 4 to 8 mg IV (subcutaneous administration is effective in milder cases); may repeat in 2 to 4 hours. Avoid respiratory depression. Morphine increases venous capacity, lowering left atrial pressure, and relieves anxiety, which reduces the efficiency of ventilation.

Nitroglycerin IV, 5 to 10 ug/min. Increase by 5 ug/min q 3 to 5 minutes. Reduces left ventricular preload. Caution: may cause hypotension.

Oxygen, 100% given to obtain an arterial PO2>60 mm Hg.

Position patient sitting up with legs dangling over the side of the bed. This facilitates respiration and reduces venous return.