Podcast
Questions and Answers
What is the primary reason for proceeding with chest compressions in LVAD patients experiencing out-of-hospital circulatory arrest?
What is the primary reason for proceeding with chest compressions in LVAD patients experiencing out-of-hospital circulatory arrest?
- It eliminates the need for additional medical equipment.
- It ensures the elimination of potential hypovolaemia.
- It manages the patient's anxiety during the procedure.
- It is associated with a low risk of harm and improves outcomes. (correct)
What is the role of ECG monitoring in patients receiving CPR, particularly those with an LVAD?
What is the role of ECG monitoring in patients receiving CPR, particularly those with an LVAD?
- It provides reassurance to bystanders that care is being taken.
- It is optional and not required if compressions are effective.
- It is mainly for recording purposes for future audits.
- It allows for the detection and management of arrhythmias like VF or VT. (correct)
In which circumstance should chest compressions be prioritized over the assessment of hypovolaemia in LVAD patients?
In which circumstance should chest compressions be prioritized over the assessment of hypovolaemia in LVAD patients?
- When LVAD flow is critically low and needs attention immediately. (correct)
- When the patient is responsive and communicating well.
- When the patient's vitals are stable and steady.
- When the patient has a history of high blood pressure.
What is the appropriate action to take when witnessing recurrent VF or VT in an LVAD patient during CPR?
What is the appropriate action to take when witnessing recurrent VF or VT in an LVAD patient during CPR?
Why is adherence to ALS guidelines recommended during CPR for LVAD recipients?
Why is adherence to ALS guidelines recommended during CPR for LVAD recipients?
What is a normal finding regarding blood pressure in patients with LVADs?
What is a normal finding regarding blood pressure in patients with LVADs?
What should be transported with an LVAD patient to the hospital?
What should be transported with an LVAD patient to the hospital?
Which of the following is true regarding the management of a responsive LVAD patient with VT or VF?
Which of the following is true regarding the management of a responsive LVAD patient with VT or VF?
Which statement best describes how LVADs function?
Which statement best describes how LVADs function?
As of January 2016, how many adult patients were receiving LVAD therapy in the UK?
As of January 2016, how many adult patients were receiving LVAD therapy in the UK?
What has led to an increase in LVAD implantations?
What has led to an increase in LVAD implantations?
Which of the following best describes the typical arrangement of LVAD components?
Which of the following best describes the typical arrangement of LVAD components?
Why is the measurement of blood pressure and arterial saturation described as challenging in LVAD patients?
Why is the measurement of blood pressure and arterial saturation described as challenging in LVAD patients?
What is a critical risk associated with restarting a non-functional LVAD after a prolonged period?
What is a critical risk associated with restarting a non-functional LVAD after a prolonged period?
What should clinicians first do when they assess the circulation of an LVAD recipient who is unresponsive?
What should clinicians first do when they assess the circulation of an LVAD recipient who is unresponsive?
What equipment must LVAD patients take with them to the hospital?
What equipment must LVAD patients take with them to the hospital?
What is an essential aspect of the training provided to patients discharged with an LVAD?
What is an essential aspect of the training provided to patients discharged with an LVAD?
What is often true about LVAD recipients regarding their mobility post-discharge?
What is often true about LVAD recipients regarding their mobility post-discharge?
What should be done immediately if an LVAD is discovered to have stopped?
What should be done immediately if an LVAD is discovered to have stopped?
What is the purpose of the patient-specific protocol (PSP) provided to LVAD patients upon discharge?
What is the purpose of the patient-specific protocol (PSP) provided to LVAD patients upon discharge?
What should clinicians avoid in assessing LVAD recipients to prevent delays?
What should clinicians avoid in assessing LVAD recipients to prevent delays?
Why might a loud alarm signal from the LVAD controller be an important indicator?
Why might a loud alarm signal from the LVAD controller be an important indicator?
Which complication are LVAD recipients particularly vulnerable to?
Which complication are LVAD recipients particularly vulnerable to?
What might prevent an appropriate assessment of pulse in LVAD patients?
What might prevent an appropriate assessment of pulse in LVAD patients?
What is the typical time frame for LVAD non-function that raises concern for a patient?
What is the typical time frame for LVAD non-function that raises concern for a patient?
What design feature of the LVAD eliminates the possibility of using valves?
What design feature of the LVAD eliminates the possibility of using valves?
Where does the percutaneous driveline typically exit the body?
Where does the percutaneous driveline typically exit the body?
What is the first step a clinician should take when dealing with an LVAD bag before troubleshooting?
What is the first step a clinician should take when dealing with an LVAD bag before troubleshooting?
When should a clinician suspect that the LVAD controller is defective?
When should a clinician suspect that the LVAD controller is defective?
What is a primary consideration if an LVAD patient is found unresponsive?
What is a primary consideration if an LVAD patient is found unresponsive?
What should be assessed to ensure adequate circulation in an LVAD patient?
What should be assessed to ensure adequate circulation in an LVAD patient?
What should be the first action taken if an LVAD recipient shows signs of ventricular fibrillation (VF)?
What should be the first action taken if an LVAD recipient shows signs of ventricular fibrillation (VF)?
What is the acceptable mean arterial blood pressure range for LVAD recipients?
What is the acceptable mean arterial blood pressure range for LVAD recipients?
In the event of suspected cable fracture within the driveline, what action may help restore LVAD operation?
In the event of suspected cable fracture within the driveline, what action may help restore LVAD operation?
What is the controversy surrounding the application of chest compressions in LVAD recipients primarily based on?
What is the controversy surrounding the application of chest compressions in LVAD recipients primarily based on?
Which components of cardiac therapy may be installed in many LVAD recipients?
Which components of cardiac therapy may be installed in many LVAD recipients?
What should clinicians primarily look for to assess clinical signs of adequate circulation?
What should clinicians primarily look for to assess clinical signs of adequate circulation?
What should happen when active LVAD alarms are triggered?
What should happen when active LVAD alarms are triggered?
What is a common misbelief about the management of patients with LVAD during emergencies?
What is a common misbelief about the management of patients with LVAD during emergencies?
What is the role of the spare controller that patients with LVAD are advised to carry?
What is the role of the spare controller that patients with LVAD are advised to carry?
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Study Notes
Management and Resuscitation of LVAD Patients
- The prevalence of patients with LVADs is rising, with management centralized in six UK adult cardiac transplant centers.
- LVAD failure presents a critical emergency; responsive patients with ventricular tachycardia (VT) or ventricular fibrillation (VF) must be promptly transported for treatment.
- Blood pressure (BP) and arterial saturation assessment can be difficult; hypotension is common in LVAD recipients, with mean arterial BP acceptable between 60-90 mmHg.
- Dialogue with the VAD center is essential to determine the appropriate hospital for transport.
- All emergency LVAD equipment, including controllers and batteries, must accompany the patient to the hospital.
Overview of LVADs
- LVADs are internal pumps that aid cardiac function by drawing blood from the left ventricle into the aorta.
- These devices are powered externally, requiring batteries or mains electricity and an external controller.
- As of January 2016, 207 adults were on LVAD therapy in the UK, predominantly outpatient.
- LVAD recipients are primarily ambulatory adults who may travel frequently, although they face risks like stroke, bleeding, infection, and thrombosis.
- Upon discharge, patients and families receive extensive training regarding the LVAD, including emergency protocols.
Assessment Protocols
- Assessment begins with evaluating the patient’s responsiveness and breathing; unresponsiveness may indicate LVAD failure.
- For breathing patients, oxygen should be administered while identifying any other respiratory conditions.
- Identification of LVAD function is crucial; clinicians should avoid unnecessary attempts to palpate pulses in severely ill patients, as conventional methods may fail.
LVAD Troubleshooting
- If an LVAD is found not operating, immediate attempts to restart are prioritized.
- Proper power connection and charged batteries are essential for LVAD function; a working controller is crucial for restarting.
- If the primary controller fails, a spare controller should be employed; address potential cable fractures if issues persist.
Circulatory Status and Interventions
- Circulation assessment involves checking the underlying cardiac rhythm and perfusion signs, with immediate action if any issues arise.
- Many LVAD users may also have CRT pacemakers and ICDs; appropriate interventions for arrhythmias must be executed swiftly.
- Constant assessment of circulation through clinical signs is essential; hypotension can be normal in LVAD patients.
Chest Compressions and Hypovolaemia Considerations
- There is ongoing debate regarding the effectiveness of chest compressions in LVAD patients; however, short, high-quality compressions may be beneficial if traditional resuscitation fails.
- Hypovolaemia must be addressed promptly, as it can significantly impair LVAD function, necessitating rapid assessment and intervention.
Emergency Protocols
- Contact with the VAD center is critical in emergencies; patients should have identification cards that facilitate communication with the center.
- Alarm signals from the LVAD controller should be reported to the VAD center for guidance on further actions.
- Effective intervention hinges on maintaining clinical assessment standards while managing the unique challenges posed by LVAD therapy.
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