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

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LVADone

LVADone

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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
 

ah2388

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

LVADone

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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
 
OP
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LVADone

LVADone

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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...
 

reaper

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

LVADone

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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 !?!
 

amberdt03

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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


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

Sasha

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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

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

JPINFV

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

EMSLaw

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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?

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).
 

Aidey

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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.
 

Aidey

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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.
 

Sasha

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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.
 

Aidey

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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.
 

Sasha

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Would an LVAD affect an EKG?
 

reaper

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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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