Friday, July 24, 2015

Left ventricular assist devices (LVAD)


emDocs - July 24, 2015 - Author: Wood S - Edited by: Koyfman A & Long B
"What do you do if your LVAD patient isn’t awake or breathing? Since pulses likely will not be palpable, along with securing the patient’s airway, the next step is to listen over the heart for a whirring sound indicating that the pump is working. If there is no sound, look for a reason why the pump isn’t working (power supply, battery, cables). If the pump is okay, perform doppler US to determine MAP and echo to assess for tamponade, findings suggestive of PE, etc. Chest compressions arecontroversial in LVAD patients as they can theoretically dislodge the device, but may be considered on a case-by-case basis as a last resort.11
In summary, LVAD patients are a unique patient population that are at high risk for several specific types of emergencies (arrhythmias, heart failure, thrombosis, bleeding, and infection). Careful monitoring of these patients and coordination with their LVAD teams are important for their management in the ED."