Initial Treatment

We recommend clinicians consider a FONS protocol [Furosemide-Oxygen-Nitroglycerine-Sedation] (DeFrancesco, 2013).

1. Furosemide: 5 mg/kg IV, then 1-2 mg/kg IV/IM q6-8h for maintenance or a CRI (max 12 mg/kg/d)

2. Oxygen: Where possible, provide an oxygen chamber with minimal patient restraint, in preference to a mask or flow by.

3. Nitroglycerin (Glyceryl Trinitrate): 0.25–1.0 cm of a 2% transdermal ointment q 8–24 h for 1–2 d

4. Sedation: Butorphanol 0.1–0.2 mg/kg IV or IM PRN

Subsequent Treatment

After applying initial FONS stabilisation measures, we propose that clinicians consider further post-FONS options (DeFrancesco, 2013).

• Pimobendan: 0.25 mg/kg, PO, q8–12h (If the patient can safely swallow)

• Dobutamine: Dobutamine can be considered a potential life-saving measure for patients perceived to be in cardiogenic shock (hypotensive, hypothermic, low output signs)

• Diltiazem/Digoxin: if concurrent atrial fibrillation

• Thoracocentesis: If a significant if pleural effusion is identified