Unless it is definitely known that a patient has a tendency to retain carbon dioxide, all patients with severe breathlessness should be given high flow oxygen via a reservoir bag once it has been established that their airway is clear.
After the patient has been started on high flow oxygen, give frusemide 40-80 mg IV and diamorphine 2.5-5 mg IV. If matters do not improve consider isosorbide dinitrate 2-10 mg/hr IV. If matters worsen, then call the ICU sooner rather than later (assuming that the man’s condition prior to this acute presentation means that this is appropriate).
Concurrently try to establish a cause for the acute deterioration: has he had a myocardial infarction? If so, would he benefit from thrombolysis?
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