# LVAD AWARENESS for Paramedics/EMT/EMS Ambulance Companies. 911 PROTOCOL?



## LVADone (Mar 20, 2010)

_A 911 call is made. A male patient collapses and seems too sluggish to move. An Ambulance is immediately dispatched to the location.  The paramedics arrive and finds the patient sitting on the floor with his wife by his side.  The male is conscious and answers the questions the paramedics ask.  

He states he became dizzy and passed out.  The patient continues to say that he has a Left Ventricular Assist Device (LVAD) implanted and grafted to his heart.  The LVAD helps pump oxygen-enriched blood that his damaged heart can not do.  The male patient also claims that due to the design of the LVAD, basic equipment WILL NOT detect his Blood Pressure nor Pulse.  Special Dopler equipment will detect his vitals._

http://api.ning.com/files/UlNjvG5vp...BxvKB5U9vYh01jHjmXa1k4/HeartMate2THORATEC.jpg

It appears that the patient has lost color and is sweating.  What next?  There is a titanium heart/blood pump implanted to his heart.  If  needed, *are chest compressions dangerous for this patient*?  The answer is YES!  It can cause the LVAD to dislodge from the heart and the the patient can internally bleed.

I am a 47 yo male with an LVAD implant. *I DONT HAVE the conventionally found Blood Pressure and i do not have a Pulse*,  However i am alive and well 
I am trying to raise awareness of *LVAD 911 PROTOCOL* and to obtain more info from you the experts on how to spread this crucial topic.  *It is predicted that the LVAD will be as common as dialysis.*

WHAT are your questions and or experiences?

*I started a blog: 

http://www.FromTheBottomOfMyLVAD.blogspot.com

showing the "Day In The Life Of AN LVAD RECIPIENT"*

Thanks for your Help and interest.
Josh Morris

*PS my son is EMT in NYC*


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## reaper (Mar 20, 2010)

I applaud you for taking the time to do this. It may enlighten a lot of people in EMS that have no knowledge of LVAD use. I have treated many LVAD Pt's. The first one did have me spinning, not knowing what to do. Research is a great thing. They are becoming more popular and EMS needs to know how to deal with them.

Thanks again for taking the time to contribute.


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## LVADone (Mar 20, 2010)

reaper said:


> I applaud you for taking the time to do this. It may enlighten a lot of people in EMS that have no knowledge of LVAD use. I have treated many LVAD Pt's. The first one did have me spinning, not knowing what to do. Research is a great thing. They are becoming more popular and EMS needs to know how to deal with them.
> 
> Thanks again for taking the time to contribute.



Thanks for that BUT the applauds go to you and this EMT community/ 1st responders that save lives... day in and day out!!!

THANK YOU


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## trevor1189 (Mar 20, 2010)

Very interesting post, I'm sure 90% of the EMS community would be flustered on a patient like this. Interesting post.


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## EMSLaw (Mar 20, 2010)

trevor1189 said:


> Very interesting post, I'm sure 90% of the EMS community would be flustered on a patient like this. Interesting post.



Yes, I'm quite sure many of us would be, and I will include myself in that.  

I read the blog, and it's very interesting.  I'm glad this is something that I now know about.  

My question is - what is the treatment protocol here?  If someone with one of these was found unconscious, they would be pulseless by definition, leading to potentially fatal CPR.  At least now, I know what an LVAD looks like, so I'd know to be concerned, but how could we tell if the patient was unconscious because he fell and hit his head, as opposed to being in cardiac arrest?


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## LVADone (Mar 20, 2010)

EMSLaw said:


> Yes, I'm quite sure many of us would be, and I will include myself in that.
> 
> I read the blog, and it's very interesting.  I'm glad this is something that I now know about.
> 
> My question is - what is the treatment protocol here?  If someone with one of these was found unconscious, they would be pulseless by definition, leading to potentially fatal CPR.  At least now, I know what an LVAD looks like, so I'd know to be concerned, but how could we tell if the patient was unconscious because he fell and hit his head, as opposed to being in cardiac arrest?



One of my "discharge agreements" from the hospital was that my Hospital MUST speak with my local:

Fire Dept

Ambulance Corp (covering 911 calls in my nieghborhood)

Police Dept

This way when my address pops up, they already know of my implant and already know what to do as the hospital sent them information.

My concern is if an LVAD patient is enjoying his day in another community and collapses... what can/will the paramedics do there.  Its probaby a safe bet for LVAD recipients to carry a "User Manual" with them until this LVAD is a common household word like Dialysis...;-)

thanks


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## LVADone (Mar 20, 2010)

trevor1189 said:


> Very interesting post, I'm sure 90% of the EMS community would be flustered on a patient like this. Interesting post.



So true 90% would be uninformed but its not their fault.  Local hospitals that have the LVAD program should disseminate info to all 1st responder agencies in their nieghborhoods as well as the corporations that manufacture the LVAD (there are a few) should release info on their websiites for you folks.

I am in the process of receiving How to revive and secure a LVAD recipient.  Once i do, i will it post here.

The FDA approved this LVAD on 2 classes:

Bridge To Transplant

Destination Therapy

Therefore The LVAD will be a common thing in our everyday world very soon; saving the lives of 10s of thousands of people.  It will be as common as Dialysis

thanks...

PS... i guess its not a good idea to drive the ambulance like you stole it when there is a Patient in the back ...huh?


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## Seaglass (Mar 20, 2010)

I know very little about them. Look forward to learning more. In the meantime, I have a few quick questions: 

How long is the battery life away from the base unit?

If your home experiences power failure, will the disconnection alarm still work to alert you?

Can the system you wear tolerate severe heat/cold, getting wet, etc.?


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## firetender (Mar 20, 2010)

*Edgar Allan Poe would understand!*

You brought up a great topic that makes me wonder:

Edgar Allan Poe, one of our finest American writers, had epilepsy. It drove so much of his writing, and a consistent fear for him was that he would be in a neighboring town where no one knew him, suffer a seizure, be taken for dead and buried. (He actually had a system installed in his coffin so he could let the medics know they goofed!)

It's be great if more people like yourself would post here, letting us know of those anomalies of treatment or disease medics might encounter and where. Maybe there should be a thread specifically dedicated to this so everyone on this site could have easy access. 

More than anything, Thank You for your appreciation, and blessings to you and yours.


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## amberdt03 (Mar 20, 2010)

We have a patient with an LVAD in my fire district. A nurse from Baylor is going to come and do a class for us. I won't be able to attend unfortunately do to me having school that day. But I do plan on going to the house and when the family is able to, teach me about it.


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## LVADone (Mar 20, 2010)

Seaglass said:


> I know very little about them. Look forward to learning more. In the meantime, I have a few quick questions:
> 
> How long is the battery life away from the base unit?
> 
> ...



*How long is the battery life away from the base unit?*

I am lucky as i have the "new" lithium batteries that lasts 12-14 hours... however my batteries have lasted 18+ hours.   When i leave the house i must bring 2 spare batteries.

The older Acid/lead batteries last approx 4 hours. When recipients with this style batteries leave the house, they must bring 4-6 spare batteries.

*If your home experiences power failure, will the disconnection alarm still work to alert you?*

In the event of a power outage, the Power Base Unit (PBU) has a back up battery inside and provides power.  The alarms still work and and loud enough to wake up the dead 

*Can the system you wear tolerate severe heat/cold getting wet etc?*

The system Controller worn around the waist CANNOT withstand the elements as it is a computer that actually monitors and regulates the LVAD... this LVAD spins its pump (for me) 8,600 rpms... other recipients have a higher rpm.  So rain, coldness and heat at long lengths of time... especially by the oven in the kitchen should be avoided.   

AS FAR AS the entry point, where the driveline enters my lower adomen, this is dressed with guaze and film/tape to keep it clean. a binder is worn around the lower body to cover the dressing and to prevent the driveline from pulling on the entry point.  ALSO *this area must be kept dry at all times so that the chance of infections are kept low. *

thanks


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## 8jimi8 (Mar 20, 2010)

Does this mean that you are on a transplant list?

What was your ejection fraction before the treatment?

Hope you don't mind the personal questions.

Thank you for your efforts at spreading awareness


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## LVADone (Mar 20, 2010)

firetender said:


> You brought up a great topic that makes me wonder:
> 
> Edgar Allan Poe, one of our finest American writers, had epilepsy. It drove so much of his writing, and a consistent fear for him was that he would be in a neighboring town where no one knew him, suffer a seizure, be taken for dead and buried. (He actually had a system installed in his coffin so he could let the medics know they goofed!)
> 
> ...



Thanks... Good Ol Edgar Allan Poe's house is just 3 miles from mine, in the Bronx (NY)... off the Grand Concourse and open to the public...yeah he had it rough and on top of it all his wife suffered from depression and was suicidal.

Opening up a THREAD is new to me... but if ADMIN wants, i dont mind

Thanks again and YES blessings to you and yours as well!


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## LVADone (Mar 20, 2010)

amberdt03 said:


> We have a patient with an LVAD in my fire district. A nurse from Baylor is going to come and do a class for us. I won't be able to attend unfortunately do to me having school that day. But I do plan on going to the house and when the family is able to, teach me about it.



*Its nice that Baylor has an outreach program like this. Is it given in general or just because of the Patient living in your jurisdiction?*

thanks


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## LucidResq (Mar 20, 2010)

I wish all my patients took this much initiative to be informed and proactive about their conditions and interventions.


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## LVADone (Mar 20, 2010)

8jimi8 said:


> Does this mean that you are on a transplant list?
> 
> What was your ejection fraction before the treatment?
> 
> ...



Nice question!  my EF was around 0.10...  i think... i have a doctors appt on monday and will find out exactly.  *i do remember that my heart was only functioning at 13% capacity.*

Yes i am on the transplant list... i am O neg so they think here in NYC, i will have a 3 year wait...  SOMETIMES THE LVAD GIVES THE HEART TIME TO rest and can repair itself... kinda like hibernation... we'll see

Thanks


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## LVADone (Mar 21, 2010)

LucidResq said:


> I wish all my patients took this much initiative to be informed and proactive about their conditions and interventions.



LOL thank you, i feel blessed enough to be living, so this is my way of thanking the "LVAD"... If my heart attack occured 5 or 3 years ago I wouldnt be around.

Most times i feel so normal that i have the LVAD implant... until one of my wires gets caught up on a door knob! 

This is my 1st EMT forum to discuss, i will join others...

thanks


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## 8jimi8 (Mar 21, 2010)

LVADone said:


> Nice question!  my EF was around 0.10...  i think... i have a doctors appt on monday and will find out exactly.  *i do remember that my heart was only functioning at 13% capacity.*
> 
> Yes i am on the transplant list... i am O neg so they think here in NYC, i will have a 3 year wait...  SOMETIMES THE LVAD GIVES THE HEART TIME TO rest and can repair itself... kinda like hibernation... we'll see
> 
> Thanks



Do you remember all of the factors that lead your doctor to consider the use of the LVAD.  From what I read you said that your EF was 10% and that your total heart function was 13%?  I am glad that this intervention has somewhat given you a normal life again!


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## LVADone (Mar 21, 2010)

8jimi8 said:


> Do you remember all of the factors that lead your doctor to consider the use of the LVAD.  From what I read you said that your EF was 10% and that your total heart function was 13%?  I am glad that this intervention has somewhat given you a normal life again!



www.FromTheBottomOfMyLVAD.blogspot.com i discuss it in length, the factors and indicators of my heart attack... Originally I thought i had Food poisoning! I HAD NO chest pains nor left arm pain or numbness.  I stayed home for a week and noticed i couldnt walk more than 10 feet before falling out of breath. I couldnt even hold my 6 month old grandson!!! so we called a close friend of mine who is a physician.  he layed me on the floor and examined me... he found that my heart rate was 140!  he then sent me to emergency. 

At emergency, they hooked me up to an EKG and thought i was having a heart attack then!  i wasnt, i had it already... a week prior.

This hospital then sent me to Columbia Presbyterian Hospital in NYC because it was technologically advanced  (its where president Clinton has his heart taken care of).

So after having a stent placed and being in the hospital for a week, i was discharged.   But then was re-admitted 3 days later as i still couldnt walk more than 10 feet and developed a bad "Cardiac Cough".

It was then, i took on a new Doctor, and she told me i can be re-admitted again and again as my heart wasnt getting any better and my other organs could fail, she said my only prayer was a transplant... but 1st the LVAD! 

And yes, i do have a pretty normal life... considering what is makin me tick 

thanks


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## amberdt03 (Mar 21, 2010)

LVADone said:


> *Its nice that Baylor has an outreach program like this. Is it given in general or just because of the Patient living in your jurisdiction?*
> 
> thanks



Its just because he lives in our district. I definitely look forward to learning about it. We have already had it set up in dispatch so that when his address is typed in, they can alert us that its him. The paperwork that was sent to our fire station says he must be transported to Baylor Dallas, which would be an hour drive via ambulance. And I already know what's going to happen. We will get called out to him when its crappy weather and we can't get a helicopter. I have asked one of the medics that works the ambulance to ask the nurse in the case of bad weather, if we can transport him to the closest Baylor, or does he need to go all the way to Dallas.


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## ajax (Mar 21, 2010)

do you wear medical id?


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## LVADone (Mar 21, 2010)

amberdt03 said:


> Its just because he lives in our district. I definitely look forward to learning about it. We have already had it set up in dispatch so that when his address is typed in, they can alert us that its him. The paperwork that was sent to our fire station says he must be transported to Baylor Dallas, which would be an hour drive via ambulance. And I already know what's going to happen. We will get called out to him when its crappy weather and we can't get a helicopter. I have asked one of the medics that works the ambulance to ask the nurse in the case of bad weather, if we can transport him to the closest Baylor, or does he need to go all the way to Dallas.



Thats the problem, not all hospitals have an LVAD program, and if it does it may not use "that" particular LVAD... mine is made by THORATEC called the 
Heartmate ll.

I heard of stories that an LVAD patient from NYC needed assistance in Philly and that hospital didnt want to touch him dispite  the fact that they were familiar with his LVAD... because of insurance purposes...   his health rapidly declined and the hospital in philly did help him.

They recommend that an LVAD patient shouldnt be futher than 2 hours from the hospital he or she had surgery in.   But folks with LVADs do travel by airplane car bus BUT its not recommended.

thanks

*BTW  I am trying to add a signature to my comments but i cant find where to add... do you?   thanks*


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## JPINFV (Mar 21, 2010)

http://emtlife.com/profile.php?do=editsignature


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## ah2388 (Mar 21, 2010)

I'm definitely interested in the 911 protocol in place to revive LVAD patients.  Please post it when you find it!


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## LVADone (Mar 21, 2010)

ajax said:


> do you wear medical id?



 My son(he is an EMT) is in process of ordering  Med ID for me that i will wear around my neck...  currently hospitals are trying to figure out the "proper" info to place on the Med ID...

so much to note: Patient has Heart pump implanted, patient has NO PULSE patient has no recognizable blood presure... No chest compressions... it goes on

But currently i do carry papers with me explaining my condition should i be found and unable to talk...

thanks


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## LVADone (Mar 21, 2010)

ah2388 said:


> I'm definitely interested in the 911 protocol in place to revive LVAD patients.  Please post it when you find it!



will do... EMTLIFE will be the 1st place that i will post it!  it will be sometime this coming week...


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## reaper (Mar 21, 2010)

I would suggest a bracelet for ID. More likely to be noticed right away.


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## LVADone (Mar 21, 2010)

reaper said:


> I would suggest a bracelet for ID. More likely to be noticed right away.



Thanks for that as it has been a debate on where to ID myself... the neclace or bracelet...  it also reminds me of a story that my son told me of a patient...

*This patient had all his conditions and medicines tatooed on his chest and arm so any visiting medical emergency team would spot it immediately LOL !?!*


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## amberdt03 (Mar 21, 2010)

LVADone said:


> Thats the problem, not all hospitals have an LVAD program, and if it does it may not use "that" particular LVAD... mine is made by THORATEC called the
> Heartmate ll.
> 
> I heard of stories that an LVAD patient from NYC needed assistance in Philly and that hospital didnt want to touch him dispite  the fact that they were familiar with his LVAD... because of insurance purposes...   his health rapidly declined and the hospital in philly did help him.
> ...




Awesome, thanks for the info. I will pass this along to everyone in my fire department and the ambulance crew.


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## Sasha (Mar 21, 2010)

I'm wondering, what are providers supposed to do if they find an LVAD patient unresponsive and apneic? 

Since they have no pulse, they could be in... arrest, as in their machine stopped working, and in that case, you are not supposed to compressions... so what, you just call it a day, pack up, and go home? 

Many areas don't transport patients who code until they have a ROSC... since you have no pulse, period, a ROSC would be totally out of the question, wouldn't it?

And I really can't see the benefit outweigh the risk of rushing someone to the hospital, unable to circulate their blood, code 3, risking everyone else's lives for someone who may not come back as anything more than a vegetable due to anoxic brain injury from lack of circulation, especially considering some areas transport times where they can reach 10 minutes to over an hour.

Or would you risk compressions knowing you possibly could dislodge the device and cause a bleed?

Also, just an off topic pure curiosity question, if you can't get it wet does that mean you can't shower?


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## JPINFV (Mar 21, 2010)

Good question. I'll see if Up-To-Date has anything on it when I get home later tonight.


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## JPINFV (Mar 21, 2010)

Hmm... couldn't find anything specific to LVADs in cardiac arrest either on Up-To-Date or EMedicine.


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## EMSLaw (Mar 21, 2010)

Sasha said:


> I'm wondering, what are providers supposed to do if they find an LVAD patient unresponsive and apneic?
> 
> Since they have no pulse, they could be in... arrest, as in their machine stopped working, and in that case, you are not supposed to compressions... so what, you just call it a day, pack up, and go home?
> 
> ...



Those were the same questions I had (well, except for the shower thing! ).  And cardiac drugs won't help, right, because the patient's heart is already effectively damaged beyond repair, or they wouldn't have the LVAD in the first place?  

I think, unless I hear otherwise, that this would have to be something like c-spine compromise in a patient in cardiac arrest - wouldn't disloding the device be the lesser of two evils, as compared to not doing chest compressions?  In a situation where the patient is apneic and unresponsive, at least.  I suppose there is no danger of defibrilation, because if the patient's pump stops, they will be effectively asystolic.   

Maybe as these devices become more common, we will start to be equipped with the proper tools to measure vital signs in LVAD patients - if they ever do become that common (look how common diabetes is - and most of the time EMT-Bs don't use glucometers).


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## Aidey (Mar 21, 2010)

We have a LAVD program at one of our local hospitals, and we also have about 10 pages of LAVD protocols in our books, including step by step instructions on how to run the thing, complications etc. It's actually so long because I think it covers 3 different devices. I admit I would have to look. It's not a protocol I tried to memorize because if I need to use it I'm going to have the protocol book out. 

As explained in said protocols, the LAVD should be equipped with a manual pump. From what it sounds like it would look similar to a BP cuff pump, and you can manually run the device in the event it fails. I'm assuming that is what you would do if CPR was needed. Everything else would be run the same, but instead of compressions you would manually pump the device.


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## Aidey (Mar 21, 2010)

Ok, I stopped being lazy and went and looked up the protocol. Yes, it does have instructions for 3 separate LAVD devices. Two for different versions of the HeartMate, and one for VentrAssist. 

It gives specific instructions in how to deal with failure in each, including how to hand pump and what to look for when hand pumping. This also includes indications that the device itself has broken some how. It looks like only one of the 3 has hand pump instructions, so I'm guessing it is the only one that has that feature. For that one it says DO NOT to compressions, for the other 2 it says you can. 

Our protocols also allow for diverting to the pts "home base" to pick up back up equipment before transporting to the hospital. We do have to bring these patients to a specific hospital, and we are to notify the LAVD on call person ASAP. Even if the pt is being transported for a non cardiac issue, like a broken arm. 

There is an on-call "mechanical heart specialist" that we have a direct phone number for, and from what the protocol says, call them and they will talk us through anything we need to do. I'm guessing the person is a doctor, and can give online med direction for what we should and shouldn't do.


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## Sasha (Mar 21, 2010)

EMSLaw said:


> Those were the same questions I had (well, except for the shower thing! ).  And cardiac drugs won't help, right, because the patient's heart is already effectively damaged beyond repair, or they wouldn't have the LVAD in the first place?
> 
> I think, unless I hear otherwise, that this would have to be something like c-spine compromise in a patient in cardiac arrest - wouldn't disloding the device be the lesser of two evils, as compared to not doing chest compressions?  In a situation where the patient is apneic and unresponsive, at least.  I suppose there is no danger of defibrilation, because if the patient's pump stops, they will be effectively asystolic.
> 
> Maybe as these devices become more common, we will start to be equipped with the proper tools to measure vital signs in LVAD patients - if they ever do become that common (look how common diabetes is - and most of the time EMT-Bs don't use glucometers).



Sorry I stole your question, i somehow missed it.


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## Aidey (Mar 21, 2010)

Oh, and OP correct me if I'm wrong, but these are not the same as the artificial heart. The patient's own heart still has to be working at least a little for these to work. Therefore cardiac drugs would still be indicated, because the patients heart does still have some function left, even if it's very poor function.


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## EMSLaw (Mar 22, 2010)

Sasha said:


> Sorry I stole your question, i somehow missed it.



You're welcome to share them, Sasha. 

I didn't think of there being a hand-pump.  Another thing that's good to know.


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## Sasha (Mar 22, 2010)

Would an LVAD affect an EKG?


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## reaper (Mar 22, 2010)

Well,

I have done some reading up on LVAD's and emergency situations.

First you have two types of LVAD's. You have the Heartmate design, like the OP has. That is a continuous flow pump and does not produce pulse or BP.

Then you have a Pulsatile pump. These do have pulses and BP's.

Almost all pumps come with a manual pump, for back up. This is to be tried before Compressions are used. If it comes to that point, compressions may be used as last resort.

A pt with an LVAD will still show a sinus rhythm on the monitor. The left ventricle is the only part effected by the pump.

This is something that each provider needs to research and talk to you system about the treatment of these pt's.


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## LVADone (Mar 22, 2010)

Sasha said:


> I'm wondering, what are providers supposed to do if they find an LVAD patient unresponsive and apneic?
> 
> Since they have no pulse, they could be in... arrest, as in their machine stopped working, and in that case, you are not supposed to compressions... so what, you just call it a day, pack up, and go home?
> 
> ?





amberdt03 said:


> Awesome, thanks for the info. I will pass this along to everyone in my fire department and the ambulance crew.





JPINFV said:


> Hmm... couldn't find anything specific to LVADs in cardiac arrest either on Up-To-Date or EMedicine.





ah2388 said:


> I'm definitely interested in the 911 protocol in place to revive LVAD patients.  Please post it when you find it!





reaper said:


> I would suggest a bracelet for ID. More likely to be noticed right away.





JPINFV said:


> http://emtlife.com/profile.php?do=editsignature





ajax said:


> do you wear medical id?





EMSLaw said:


> Those were the same questions I had (well, except for the shower thing! ).  And cardiac drugs won't help, right, because the patient's heart is already effectively damaged beyond repair, or they wouldn't have the LVAD in the first place?
> 
> Maybe as these devices become more common, we will start to be equipped with the proper tools to measure vital signs in LVAD patients - if they ever do become that common (look how common diabetes is - and most of the time EMT-Bs don't use glucometers).





Aidey said:


> Ok, I stopped being lazy and went and looked up the protocol. Yes, it does have instructions for 3 separate LAVD devices. Two for different versions of the HeartMate, and one for VentrAssist.
> 
> It gives specific instructions in how to deal with failure in each, including how to hand pump and what to look for when hand pumping. This also includes indications that the device itself has broken some how. It looks like only one of the 3 has hand pump instructions, so I'm guessing it is the only one that has that feature. For that one it says DO NOT to compressions, for the other 2 it says you can.
> 
> ...





JPINFV said:


> Good question. I'll see if Up-To-Date has anything on it when I get home later tonight.





Aidey said:


> We have a LAVD program at one of our local hospitals, and we also have about 10 pages of LAVD protocols in our books, including step by step instructions on how to run the thing, complications etc. It's actually so long because I think it covers 3 different devices. I admit I would have to look. It's not a protocol I tried to memorize because if I need to use it I'm going to have the protocol book out.
> 
> As explained in said protocols, the LAVD should be equipped with a manual pump. From what it sounds like it would look similar to a BP cuff pump, and you can manually run the device in the event it fails. I'm assuming that is what you would do if CPR was needed. Everything else would be run the same, but instead of compressions you would manually pump the device.





reaper said:


> Well,
> 
> I have done some reading up on LVAD's and emergency situations.
> 
> ...



*Thanks ALL for your research and offering the info you have... much appreciated.*

Showers are allowed once the entry point in the abdomen heals "enough" around the driveline that powers the LVAD. BATHS and SWIMMING are not permitted.

*MY Model LVAD is the newest one called the HeartMate ll. It is a constant flow pump which causes me not to have a pulse. ALSO my LVAD/Heartmate ll is not outfitted for a hand pump.  *

With that said,* my LVAD model is already the most popular, because it is a small device so it will fit inside all types of bodies; where the older models are too large to fit smaller framed people... especially women.  Another point why this LVAD is the most common is because it has only 1 moving part, reducing the risk of breakdown.*

My hospital told me that THORATEC does have a website called thoratecU.com where medical professionals can register/take FREE online courses/download material etc. * It also offers a Emergency Response program.*

thanks.

Again...

*www.thoratecU.com* for* FREE *online courses and training material


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## LVADone (Mar 22, 2010)

WHOA sorry for the LARGE font above... didnt think it would be o large and annoying!

Anyway, *i think the bottomline is that the LVAD recipient should be carrying their manuals around with them as they travel.*  As it is we have to carry spare batteries and an extra controller/computer (worn around the waist) that monitors and powers the implanted LVAD.

Thanks


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## LVADone (Mar 22, 2010)

Sasha said:


> Would an LVAD affect an EKG?



The EKG is unaffected overall, as it still reading the heart's function/activity, although the LVADis performing its task, the heart is still doing its job of pumping, however to med professionals familiar with the LVAD, they can see a slight difference.

thanks


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## LVADone (Mar 22, 2010)

Aidey said:


> Oh, and OP correct me if I'm wrong, but these are not the same as the artificial heart. The patient's own heart still has to be working at least a little for these to work. Therefore cardiac drugs would still be indicated, because the patients heart does still have some function left, even if it's very poor function.



CORRECT, IN FACT THE LVAD ALLOWS THE HEART TO REST AND REPAIR ITSELF TO THE POINT THAT SOME RECIPIENTS ARE BLESSED WHERE THEY DONT HAVE TO GET A TRANSPLANT AS THE HEART RETURNED TO NORMAL... they call it hibernation.

*Technically its a partial or Half of a mechanical heart!*

thanks


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## reaper (Mar 22, 2010)

Excellent website. Thank you for the link. I am halfway through it and it is very informative.

Thanks again for starting this thread.


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## LVADone (Mar 22, 2010)

reaper said:


> Excellent website. Thank you for the link. I am halfway through it and it is very informative.
> 
> Thanks again for starting this thread.



Glad you are making good  use of it, i tried to register and they told me "patients" are prohibited LOL...

Thanks for your passion in saving lives...


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## reaper (Mar 22, 2010)

Yes, they only let you register if you have an email account associated with a hospital or agency! Weird, but I guess they have their reasons. It is a good site though.


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## LVADone (Mar 22, 2010)

reaper said:


> Yes, they only let you register if you have an email account associated with a hospital or agency! Weird, but I guess they have their reasons. It is a good site though.



Thoratec sent me 3 emails and called me 2 times to apologize... and explained why... something about it being a online school and the Law with an Attorney General would penalize them LOL   i already forgot exactly LOL

But they appreciate what i am doing and eventually I will be able to get in as my Son who is an EMT, will let me look over his shoulder... he will join EMTLIFE soon.

thanks


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## JPINFV (Mar 22, 2010)

I'll see if they'll let me register an account as a medical student. I used my .edu account and listed my job title as a med student.


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## reaper (Mar 23, 2010)

It should, as long as your email is associated with the school.


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## firecoins (Mar 23, 2010)

LVADone said:


> _A 911 call is made. A male patient collapses and seems too sluggish to move. An Ambulance is immediately dispatched to the location.  The paramedics arrive and finds the patient sitting on the floor with his wife by his side.  The male is conscious and answers the questions the paramedics ask.
> 
> He states he became dizzy and passed out.  The patient continues to say that he has a Left Ventricular Assist Device (LVAD) implanted and grafted to his heart.  The LVAD helps pump oxygen-enriched blood that his damaged heart can not do.  The male patient also claims that due to the design of the LVAD, basic equipment WILL NOT detect his Blood Pressure nor Pulse.  Special Dopler equipment will detect his vitals._
> 
> ...



weunder strict orders to take such pts to Columbia Pres.


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## firecoins (Mar 23, 2010)

LVADone said:


> www.FromTheBottomOfMyLVAD.blogspot.com This hospital then sent me to Columbia Presbyterian Hospital in NYC because it was technologically advanced  (its where president Clinton has his heart taken care of).



It is the only hospital in the NYC area that I know that can treat patients with LVADs.


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## LucidResq (Mar 23, 2010)

Mr. Morris - 

I think you'll be happy to hear that the famous anatomy exhibition Body Worlds and the Story of the Heart features an LVAD in situ (as it is normally is placed, displayed in a real human heart) and an informational video on how it works. I saw it yesterday when I visited the exhibit at my local museum. 

This is an extremely popular world-wide touring exhibition of real human specimens preserved with a ground-breaking technique. I know a lot of health care students and professionals see this exhibit, and although it doesn't give any information as far as assessing or treating a LVAD recipient, at least it is planting the seeds of awareness and curiosity.


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## mycrofft (Mar 23, 2010)

*Now THIS is EMNTLIFE at its finest.*

Or am I thinking about finding the right knife, window punch, boots, roof lights, sidearm...B)

Here's a supporting quick and dirty. Notice, NO EMS specific material, gotta thik.

OP, have any materials about what CAN be done for LVAD bearers? Jumper cables? Call AAA? (Sorry, see my avatar's caption).

Great post, I'm asking for permission to link to it elsewhere.


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## LVADone (Mar 23, 2010)

firecoins said:


> It is the only hospital in the NYC area that I know that can treat patients with LVADs.



columbia pres was the 1st and is the most tech advanced... Montifiore hosp in the bronx started an LVAD program recently AND Westcher Hospital has started one too... in fact i hear on 1010wins news radio Westchester hospital is starting to advertise the their LVAD programs... the news and the LVAD is spreading 

thanks


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## mycrofft (Mar 23, 2010)

*Apologize for reply above.*

Link didn't post.

Thanks for permission to cross link to you blog.


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## LVADone (Mar 23, 2010)

LucidResq said:


> Mr. Morris -
> 
> I think you'll be happy to hear that the famous anatomy exhibition Body Worlds and the Story of the Heart features an LVAD in situ (as it is normally is placed, displayed in a real human heart) and an informational video on how it works. I saw it yesterday when I visited the exhibit at my local museum.
> 
> This is an extremely popular world-wide touring exhibition of real human specimens preserved with a ground-breaking technique. I know a lot of health care students and professionals see this exhibit, and although it doesn't give any information as far as assessing or treating a LVAD recipient, at least it is planting the seeds of awareness and curiosity.



Nice! i didnt know that, but it shows me/us that this LVAD is a serious subject that they thought  willing to display... it really is the wave of the future... case in point, a few years ago if i had my heart attack, I WOULDNT be here exchanging info with you, writing my blog or being with my wife and family  

*BTW i have on my blog VIDEOS on how this LVAD WORKS AND AN early LVAD operation... *

*http://fromthebottomofmylvad.blogspot.com/2010/02/lvad-videos.html*

thanks...


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## LVADone (Mar 23, 2010)

mycrofft said:


> Link didn't post.
> 
> Thanks for permission to cross link to you blog.



 Thank you... this is my goal to inform and get informed 

Thanks again


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## LVADone (Mar 23, 2010)

mycrofft said:


> Link didn't post.
> 
> Thanks for permission to cross link to you blog.





sorry, i didnt see this until now...  what "Link didnt post"

thanks


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## Jon (Mar 23, 2010)

Josh,

Thanks again for being willing to share... this is a awesome resource.

I've known of LVAD's prehospitaly in my area for over 5 years now. Haven't had the chance to transport a LVAD patient yet... but it is going to happen sooner or later.

Not only does the hosptial notify the primary EMS agency, the hosptial and/or the primary EMS agency notify their backups. In recent months, I've been aware of 3 patients living in my second-due area, and one that attended daily rehab sessions in my first-due.

We've also discussed the potential need for aeromedical transport for these patients to the LVAD center, in at least one case making a helicopter being placed on standby part of the dispatched response for an EMS call at that residence... we are located about 30-45 minutes by ground to the various LVAD centers.

Something I haven't seen yet - when the LVAD recipient leaves the house, they MUST have a trained companion with them - the companion is supposed to know how to troubleshoot the pump and be able to assist responders if needed... MAKE SURE TO LISTEN TO THAT PERSON! They are a subject matter expert... and you aren't.

Jon


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## LVADone (Mar 23, 2010)

Jon said:


> Josh,
> 
> Thanks again for being willing to share... this is a awesome resource.
> 
> ...



Hi jon...thanks for sharing that and the protocols.  There is no doubt that the LVAD recipient will be more common place in the world... for many reasons...bottom up and top down perspectives... thats for another post 

But we are finding LVAD regulations vary state to state regarding if they should be alone at times and or drive a vehicle alone at times as it will be impossible to be with a trained companion at all times... my wife, mother...children are all trained. However i and my hospital come from the school that LVAD recipients should take control and know more than most... thats why on my blog i wrote the LVAD CREED 

In Utah they actually have "automobile driving tests" for LVAD patients/recipients where they literally shut off the LVAD as you drive to see if you can handle pulling the vehicle over and deal with the weaning LVAD...

Anyway... it is my prediction that the LVADer will be out and about... alone eventually and i hope the rest of the world doesnt treat them like zombies 

thanks for your great perspective on this

josh


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## berkeman (Mar 24, 2010)

LVADone said:


> My son(he is an EMT) is in process of ordering  Med ID for me that i will wear around my neck...  currently hospitals are trying to figure out the "proper" info to place on the Med ID...
> 
> so much to note: Patient has Heart pump implanted, patient has NO PULSE patient has no recognizable blood presure... No chest compressions... it goes on
> 
> ...



If you are unresponsive, I don't generally check for papers.  I do check for bracelet and anklet IDs.  Get one soon please!  Thanks for the thread.


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## LVADone (Mar 24, 2010)

berkeman said:


> If you are unresponsive, I don't generally check for papers.  I do check for bracelet and anklet IDs.  Get one soon please!  Thanks for the thread.



I just got home from a dinner with a THORATEC (manufacturer of the HEARTMATE ll LVAD) representative...

Among many questions i raised, Medical ID was raised and type was a concern. Neclace bracelet anklet...etc they are suggesting LVAD recipients should wear neclace or anklet as the Bracelet can get hung up on one of the LVAD wires and damage it in everyday use...  

So thanks for your concern and it makes sense that papers arent effective as emt/paramedics arent allowed to flip through someones bag or wallet.

thanks!


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## reaper (Mar 24, 2010)

Trust me, if you are found unresponsive with an LVAD attached, I am going through wallet,pockets, and any bags. Long before I look at a necklace. 

I want real info on the device, not a short sentence. The best thing to put on the ID tag, is the phone number for the LVAD support!


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## LVADone (Mar 24, 2010)

reaper said:


> Trust me, if you are found unresponsive with an LVAD attached, I am going through wallet,pockets, and any bags. Long before I look at a necklace.
> 
> I want real info on the device, not a short sentence. The best thing to put on the ID tag, is the phone number for the LVAD support!



Nice... i like your feisty passion... to save a life... it will eventually be protocol for LVADrecipients to showcase the number of their LVADsupport team on the equipment that we are wearing... i do already, taped to my batteries and controller around my waist.

the Paramedic, who brought me to the hospital, kept in touch with me everytime he had to transport someone to the hospital... she would even call up my nurse to see how i was doing... conflict of interest to get keep in touch with a patient you transported?  i dont know, but it was folks like her that gave me more drive...

God Bless the 1st responders!


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## LVADone (Mar 24, 2010)

Aidey said:


> We have a LAVD program at one of our local hospitals, and we also have about 10 pages of LAVD protocols in our books, including step by \.





Sasha said:


> Sorry I stole your question, i somehow missed it.





EMSLaw said:


> You're welcome to share them, Sasha.
> 
> I didn't think of there being a hand-pump.  Another thing that's good to know.





reaper said:


> I have done some reading up on LVAD's and emergency situations.
> 
> This is something that each provider needs to research and talk to you system about the treatment of these pt's.





ah2388 said:


> I'm definitely interested in the 911 protocol in place to revive LVAD patients.  Please post it when you find it!





amberdt03 said:


> Awesome, thanks for the info. I will pass this along to everyone in my fire department and the ambulance crew.





LucidResq said:


> I wish all my patients took this much initiative to be informed and proactive about their conditions and interventions.





trevor1189 said:


> Very interesting post, I'm sure 90% of the EMS community would be flustered on a patient like this. Interesting post.





Seaglass said:


> I know very little about them. Look forward to learning more. In the meantime, I have a few quick questions:
> 
> How long is the battery life away from the base unit?
> 
> ...





firetender said:


> You brought up a great topic that makes me wonder:
> 
> Edgar Allan Poe, one of our finest American writers, had epilepsy. It drove so much of his writing, and a consistent fear for him was that he would be in a neighboring town where no one knew him, suffer a seizure, be taken for dead and buried. (He actually had a system installed in his coffin so he could let the medics know they goofed!)
> 
> ...





8jimi8 said:


> Does this mean that you are on a transplant list?



*tonight i learned from THORATEC that"chest compressions" are not officially  ruled out.  But used as a last resort*

i guess it can be found on the thoratecU.com website... which i havent gotten into yet ;-)
thanks


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## MedicSupv (Mar 15, 2011)

reaper said:


> Well,
> 
> I have done some reading up on LVAD's and emergency situations.
> 
> ...



We have a cardiac rehab facility in our fire district and have gone for extensive training on these pumps. The majority of the patients that have had recent fitting of the devices will have the Heartmate II pump. This is the newest technology and considered permanent. Lithium batteries that last 3-4 times longer than the other pumps. They do have spare batteries and a hand pump, if the patient carries them as instructed. They do not always have the batteries with them. 

Under no circumstance is the patient to get chest compressions with these pumps. You normally have an AICD/Pacer implanted at the same time or prior to the pump. Not all patients have this, it's dependent on the right ventricular function, however most do. Therefore, you normally get a wide complex and it could be a sinus rhythm or a tachacardia, but it should be a wide paced rhythm. Again, every patient is different, but vaguely stating a sinus rhythm may mislead a provider as far as what they are looking for.

You can take a blood pressure if you have a doppler device, there are inexpensive units out there that are worth getting if you have a facility in your district as ours. We have found that the average bp is between 72-80mm Hg. Again, that may fluctuate, ask the patient, they should know if they are alert.

If the patient is conscious and appears to be mentating and perfusing, don't worry about the pulselessness of the patient. If they look in distress, treat them as so, expiditiously. Take the extra transport time to the proper facility if stable, the outcomes are much better.


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## MedicSupv (Mar 15, 2011)

*Question for LVADone*

How are you doing? It's been a year since your last post, just curious.


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## LVAD FRIENDS (Aug 30, 2011)

Hey Josh AKA LVAD ONE. I am another LVADer that found this site. I was married to a Medic and have quite a few as my friends.I am also one of maybe 2 LVAD patients in my County. I am suprised that the Company she works for doesnt deem it a necessity to train their employees  about the requirements of LVADs. I am not comfortable having someone responsible for me that doesnt know whats going on.Not an Expert but the basics would be nice. From what I have read you know about the lack of BP's,pulses and Heartbeats. But do you know to look for that Little Black escape Bag we  carry whenever we leave home?Dont transport us without it,it contains 2 batteries and an extra controller that might come in handy. Feel free to ask me questions ,as I told some of my EMT friends they arent unEducated about LVADs most are under educated.Ask ,I love to talk about it.It's kept me alive since May 5,2010, while I await a transplant.


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## bstone (Aug 31, 2011)

For your viewing pleasure:

http://www.youtube.com/watch?v=I4r5_3uS0Nc


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## bhawthorne (Jan 13, 2012)

*LVADs in Massachusetts*

Thanks so much for this thread. I know it is nearly a year old, but as an EMT in Massachusetts, I just saw that VADS have been added as a special consideration in our standard treatment protocols (Appendix W of our protocols at the mass.gov website /eohhs/docs/dph/emergency-services/treatment-protocols-1001.pdf). I can't wait to get some training about this, since nothing in the treatment protocols or on the Thoratec website actually shows me what a patient with a VAD installed looks like! The protocols tell me what to do if I encounter a patient with a VAD, but give no hints as to how I would know. 

From the hints on the Thoratec website, I gather that there is some sort of device strapped to outside of the patient that drives the internal device. Loads of great diagrams of how the internal device works, but no pictures of actual patients with the device. All of the medical provider data is aimed at doctors and nurses in a hospital setting, with nothing I could see for pre-hospital emergency care of the VAD patient. 

Does anyone have any hints as to where I could find this info, while I wait for our service to roll out training on the new protocols?


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## bw2529 (Jan 14, 2012)

LVADone said:


> One of my "discharge agreements" from the hospital was that my Hospital MUST speak with my local:
> 
> Fire Dept
> 
> ...



Kudos to your hospital for doing that. I have to admit, I had no idea what an LVAD was before your post (I'm an EMT-B student).

Thanks for the education, and for inspiring me to want to do more research on the subject!


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## medicdan (Jan 14, 2012)

I just attended training at M&M this past week on LVADs, very cool! We are now doing more and more discharges of LVAD patients from a designated ?installation? center, for cardiac and non-cardiac complaints of LVAD users. In fact, I transported in the last week, one of whom had an intrinsic rhythm of V-Tach. We used our monitor, but it alarmed the entire way. 

LVADone, do you have the HeartMate II? Has anyone here seen a different model or RVAD/BiVAD?


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## Ramis46 (Jan 14, 2012)

This is an Awesome Thread, And After reading over it, i didn't notice, or maybe just read over it without knowing, Your on a list for a new Heart, and on your blog you kinda have a little deal about getting ready for a heart, but i was kinda wondering how much physical activity from normaly walking to a slight jog or bike ride does the LVAD allow you to participate in. 
We do have a gentlemen in our area with one since last year, and we got a pampflit of what it was for study material. you can imagine that there is some stressors when our closest heart center is over an hour by ground, and in the midwest weather is unpredictable during the best seasons. That being said was there another site (that again i didn't see that talks about emergancy protocals anf trouble shooting for the LVAD).

Thanks for the thread.


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