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

 

WTF? = What the …fanny-pack?mr06072013p1

 

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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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

Latest posts by Jay Khadpe MD (see all)

Categories: Morning Report

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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