May 26, 2021
Contributor: Chris Holmes, MD
Educational Pearls:
- Medicine is cyclical and practice is always evolving
- A description of recommended treatment for CHF from 1966
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- Give oxygen
- Give one dose morphine then switch to demerol
- Decrease venous return and start PPV
- Immediately apply tourniquet to 3 extremities rotating tourniquets every 20 minutes
- Phlebotomy of 350-500 cc blood into a donor bag and draw off plasma as RBCs settle down
- Give aminophylline (make sure it is warmed)
- Induce hypotension with nitroglycerin and trimethoprim camphorsulfonate (infused at 10 drips/minute)
- Start digitalis
- Don’t use any diuretics as they are ineffective
- If in shock, release tourniquets and hang the phlebotomized blood
- Isoproterenol might be beneficial
References
Messer JV. Management of emergencies. 13. Acute cardiac decompensation. N Engl J Med. 1966;274(26):1491-1493. doi:10.1056/NEJM196606302742608
Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD
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Photo Credit: Photo presented without modification courtesy of Kipp Teague , CC license