Special Operations Forces Medical Handbook

4-3

Plan:

Treatment

1. Put the patient at bedrest to reduce myocardial oxygen demand.


2. Provide supplemental oxygen to bring the oxygen saturation above 95%.


3. Attach cardiac monitor if available and treat any malignant arrhythmias (See Cardiac Resuscitation
   procedure).


4. Nitroglycerin 0.4 mg sublingual q 5 minutes X 3 doses, or until pain relief
   -Check BP between doses, do not give if systolic BP below 90
   -If BP drops below 90, give 500 cc normal saline boluses until BP returns to >100 systolic


5. IV of normal saline at 100 cc/hr


6. Aspirin 325 mg po q 24 hours if not contraindicated.


7. For severe pain, Morphine 2 mg IV q 5 minutes until pain relief or sedation. Monitor respiratory status
   closely.

Patient Education
General: Healthy lifestyle may help prevent AMI.
Activity: Maintain bedrest to minimize cardiac oxygen demand.
Diet: Sips of water only for first 6-12 hours, then small, light meals, preferably clear liquids only.
Prevention: Make lifestyle changes to minimize cardiac risk factors.

Follow-up Actions
Evacuation/Consultant Criteria: Evacuate patients suspected of AMI immediately after stabilization
treatment. Keep patient under close observation at all times. Establish phone or radio contact with medical
control as early as possible and continued until the patient reaches definitive care.

NOTE: Several enzyme markers are routinely used for diagnosis of AMI but they are not available in the field.
Thrombolytic therapy is considered only in cases of confirmed AMI.

NOTE: The Killip classification is a useful tool for assessing prognosis in association with AMI:
Killip Class I: No clinical signs of heart failure. Prognosis good, < 5% mortality.
Killip Class II: Rales bilaterally in up to 50% of lung fields, isolated S-3. Prognosis good
Killip Class III: Rales in all lung fields, acute mitral regurgitation. Prognosis fair to poor.
Killip Class IV: Cardiogenic shock. Decreased LOC, systolic BP 90 or less, decreased urine output,
pulmonary edema, cold, clammy skin. Prognosis poor, mortality near 80%.

Cardiac: Congestive Heart Failure

(cardiac vs. non-cardiac pulmonary edema)

CAPT Kurt Strosahl, MC, USN

Introduction: Congestive Heart Failure (CHF), characterized by fluid in the alveoli of the lungs, is defined
as the inability of the heart to pump enough blood to meet the demands of the tissues. CHF may be
seen following any of these conditions: pulmonary embolism, sepsis, anemia, thyrotoxicosis in pregnancy,
arrhythmias, myocarditis, endocarditis, hypertension and myocardial infarction. Other associated causes
include fluid overload due to acute renal failure, shock lung due to toxic fumes / smoke / heat inhalation of a
fire or blast that causes destruction of the alveolar surfactant, and mountain sickness (high altitude pulmonary
edema). It is easier to treat CHF after recognizing and treating any of these precipitating causes.

Subjective: Symptoms
Shortness of breath (SOB); dyspnea on exertion (DOE), dyspnea when lying down (orthopnea), or when
awakening from sleep (paroxysmal nocturnal dyspnea, or PND); swelling of the ankles and legs (pedal
edema); fatigue and nausea.