Morning Report: 6/7/2013

Here’s Dr. DiMare with today’s Morning Report!

WTF? = What the …fanny-pack?

What is an LVAD?

–       Left ventricular assist device

–       Basically an extracardiac pump

–       The LV goes from being a pumping device to just a filling chamber

–       Cannula inserted into apex of the heart pumps blood directly into the aorta via a continuous pump

• Older models are pulsatile but are rarely used now

Who gets an LVAD?

–       Those who, despite optimum medical management, cannot attain the minimal necessary cardiac output

–       Those with acute cardiac injury, ie. s/p MI

–       General categories:

• Bridge to transplant
• Destination therapy
  • Long term support, end stage heart failure, NOT transplant candidate, will never be transplant candidate
• Bridge to recovery
  • Most often post MI, give native heart time to recover
• Bridge to candidacy
  • Generally younger patients after acute catastrophic illness, used in conjunction with other means of life support
  • Attempt to allow recovery to the point of being eligible for transplant

What do I need to know in the ED?

–       If you’re not in an LVAD center, get the patient to an LVAD center

• All LVADs have a number where an MD/NP/PA can be reached 24/7

–       Patients may only have femoral pulses

–       No systolic/diastolic BP –> almost all LVADs are continous flow

• MAP is KEY 60 – 90 mmHg
• Arterial line
• Can use Doppler plus manual sphygmomanometer

“Quick” fixes:

–       Hypotensive?

• Give volume, pumps need fuel in the tank
• Listen for the motor, check the indicator light –> dead battery?
• Think clot if the motor feels warm –> heparin bolus
• Anemic –> GI bleed until proven otherwise

–       Altered?

• If febrile –> infection
• If afebrile –> ICH

–       Bleeding?

• All of these patients are on coumadin and aspirin
  • Platelets and FFP or prothrombin complex concentrate

Check the patient’s bag/pockets/family for “Rescue Cards”

–       device specific

–       walk you through mechanical failure fixes

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• Bio
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Jay Khadpe MD

• Editor in Chief of "The Original Kings of County"
• Assistant Professor of Emergency Medicine
• Assistant Residency Director
• SUNY Downstate / Kings County Hospital

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