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

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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