Pulmonary edema is life-threatening condition and therefore, treated as a medical emergency. As is the case with chronic stable heart failure, identification and correction of any precipitating causes should be attempted. However, because of the acute nature of the problem, the initial management includes a number of additional non-specific measures:

1) The patient should be in propped up position (provided the blood pressure is adequate) with the legs dangling along the side of the bed, if possible, which tends to reduce venous return.

2) 100 per cent O2 should be administered to improve oxygenation. If patient is not maintaining oxygen saturation with nasal oxygen intubation and mechanical ventilation should be considered. This increases intra-alveolar pressure, reduces transudation of fluid from the alveolar capillaries, and impedes venous return to the thorax, reducing pulmonary capillary pressure.

3) Morphine is the drug of choice. It is administered intravenously, in doses from 2 to 5 mg intravenously.  It reduces anxiety, reduces adrenergic vasoconstrictor stimuli to the arteriolar and venous beds, and thereby helps to break a vicious cycle. An antiemetic is usually given along with morphine to reduce chance of vomiting.

4) Intravenous loop diuretics produce rapid diuresis, reduce circulating blood volume and hasten the relief from pulmonary edema.

5)  Afterload reducing agents e.g. IV sodium nitroprusside at 20 to 30 µg/min in patients with systolic BP above 100 mmHg.  

6)  Inotropic support should be provided by dopamine or dobutamine where necessary.

7)  Patients with systolic heart failure who are not receiving digitalis may receive 0.75 to 1.0 mg digoxin intravenously over 15 min. 

8)Sometimes, aminophylline (theophylline ethylenediamine), 240 to 480 mg intravenously, is effective in diminishing bronchoconstriction, increasing renal blood flow and sodium excretion, and augmenting myocardial contractility.

9)  Rotating tourniquets may be applied in an effort to reduce venous return. Once the patient has been stabilized and underlying cause determined, treatment directed at correcting/improving the cause.