Podcast 675: CHF like it’s 1966

<p><strong>Contributor:  Chris Holmes, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Medicine is cyclical and practice is always evolving</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">A description of recommended treatment for CHF from 1966</span></li> <li style="list-style: none; display: inline;"> <ul> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Give oxygen</span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Give one dose morphine then switch to demerol</span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Decrease venous return and start PPV</span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Immediately apply tourniquet to 3 extremities rotating tourniquets every 20 minutes</span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Phlebotomy of 350-500 cc blood into a donor bag and draw off plasma as RBCs settle down</span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Give aminophylline (make sure it is warmed)</span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Induce hypotension with nitroglycerin and trimethoprim camphorsulfonate (infused at 10 drips/minute)</span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Start digitalis</span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Don’t use any diuretics as they are ineffective</span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">If in shock, release tourniquets and hang the phlebotomized blood</span></li> <li style="font-weight: 400;" aria-level="2"><span style= "font-weight: 400;">Isoproterenol might be beneficial</span></li> </ul> </li> </ul> <p><strong>Refere