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Emergency Medical Minute


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
    • 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


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