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   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.com/cme-courses/ and create an account.  Donate to EMM today! Photo Credit: Photo presented without modification courtesy of Kipp Teague , CC license