Thanks Rahul, this is one of the best videos I have seen. I am a PCCM fellow and this video helped me understand what I could not understand in rounds. Thanks again!
Thanks for the demonstrations. I am an 8 year LVAD patient that took a terrible fall in my RV flat on my chest 2 years ago. I was afraid that something had been damaged or moved inside my body. But after the pain of my bruised muscles healed, I felt fine and am still humming along at age 78 in October!
Thank you for your excellent presentation. I am a family practice PA in a remote area. With LVADs in more pts we all need to know as much as possible to best serve our communities and individual pts.
Thanks a million. It's an excellent, what's more, a way perfect presentation and explanation. Clearly understandable still very professional. Huge thanks!!!!!
Some LVAD patients will have pulses depending on patient and sometimes it will vary day to day in the same patient. pulse oximeters often work on them and to get a heart rate you can listen to the undulations of the pump as it loads and unloads with each heartbeat.
Thanks for your help- IM intern here trying to get a better understanding of my cardiology patients. One question- why do LVAD puts you at increased risk of PE?
We don't do calibration of the LVAD in the ER. That's best left to people who are more experienced with that equipment, the LVAD team. Thanks for your comment.
for heartware, take the patient's latest hematocrit for calibration. other facilities do the calibration if the hematocrit is +/- 5 from the previous values. u can checke ur facility's protocol.
Hi sir thank you. How much should we keep INR or APTT or act to avoid thrombus formation. How often should check the coagulation profile when the people are away from the hospital. Thank you.
Very easy to understand! A few small questions: How does the pump know when to increase supply (flow rate) to compensate for increased demand? Impact on coronary artery supply? Can you review the role of the drive line as I'm unclear how it can become infected? (I thought it was just a power and command centre supply to the pump)
when speed is increase, the flow increases. there is a differential pressure across the pump, the inlet (LV pressure) and outlet (Aortic pressure) need to have a decrease pressure difference for the pump to have an easier propelling to have an increase flow. the VAD parameters trends should be monitored to be able to trouble shoot the other causes of deviating to normal values of the VAD parameters. VAD, helps the already sick heart, with the pump functions assures blood supply to the body system including the heart - provided that other impending problems are attended (such as dehydration or low blood volume and arrhythmias that pump can trigger suction events)
What do you hear when taking the manual bp if there’s no pulsation? Also the early heartmates had an external device that we (nurses) would use instead of doing compression
LVAD bypasses the normal cardiac cycle, no korotkoff's sound will be appreciated with the use of stethoscope thereby doppler is use to take the target MAP of 65-75 mmHg (not the BP - no systolic/ diastolic readings)
Ok video, but you are misinforming people! The patient is going to be brain dead by the time you do all this troubleshooting if the LVAD is not functioning. If you do CPR, yes there is a chance you could dislodge parts and kill them further, but that is a risk, at least you may circulating blood. If you sit and do nothing and the LVAD is not functioning while you "troubleshoot" for twenty minutes the patient is definitely now brain dead. In other words, quickly troubleshoot other causes and start CPR!!!! Yes, for sure contact the LVAD center, but they can only do so much without being there, and yes listen to what they have to say as they are the experts! I understand that CPR is risky, but not doing CPR on a dead patient is just as... Also you made no mention of actually assessing the patient for signs of poor circulation, such as cyanosis, slow cap refill, diaphoresis, etc... Also please don't dumb down paramedics and make it sound like we won't have any of this figured out by the time the patient arrives at the hospital, it was especially insulting when "the patient comes through the door with paramedics" and you (assuming doctor) notice this pump, as if the paramedics are going to miss that fact! Please have more respect for EMS, we are not dumb!
+Patch Molly Thanks for your comments. I apologize, I had no intention to insult paramedics. Paramedics do an amazing job in difficult conditions. You do the hard work, we have it easy in the hospital. I truly have the utmost respect for you and do not think paramedics are dumb. Please accept my apologies. My videos are directed toward medical students, so the "dumbing down" you may have noticed is because of the lack of experience the students have compared to practicing clinicians (EMS, nurses, docs, etc). When I made the video, the recommendation was to NOT start CPR on those with an LVAD due to the theoretical fear that dislodging the ventricular connection would cause the patient to exsanguinate immediately. Your points are well taken and now the recommendation, as you say, is the hail mary pass you have to take. There's a chance the patient will die with CPR, and a certainty they'll die without it. And the connections don't dislodge as often as thought. I speculate this recommendation came from the fact that when LVAD's were new and unfamiliar, people would find a pulseless patient and immediately start CPR. A patient can be unresponsive from a myriad of reasons having nothing to do with poor cardiac output. For those with an LVAD, at least think of those first, before jumping reflexively into CPR. Thanks of your comments.
+Rahul Patwari (Rahul's EM) Doc, I am a paramedic in NJ and I learned a tremendous amount about LVADs in these two videos. I think the previous commenter was pretty harsh because the videos weren't really intended toward pre-hospital medical professionals such as EMTs and Paramedics although the information was very valuable. Clearly paramedics would have done a comprehensive exam such as assessing for spontaneous (and adequate) breathing, attached the EKG, assessed for other indicators of poor circulation (skin color, temperature, texture, etc), check a blood glucose, etc. At any rate, thank you. I will be using these videos in my EMT refresher class this week when we discuss LVAD.
Hello @patch molly, i understand your feeling... the video was presented in a very short span so to emphasized things in detailed... not everyone in the medical field has the opportunity to see what an LVAD looks like... BLS is very important but since we have this kind of new devices, compression is not always be the answer. I have been in the medical field for 15 years, the books taught us the basics but the critical thinking in every situations are acquired by experience.
Thanks Rahul, this is one of the best videos I have seen. I am a PCCM fellow and this video helped me understand what I could not understand in rounds. Thanks again!
Thanks for the demonstrations. I am an 8 year LVAD patient that took a terrible fall in my RV flat on my chest 2 years ago. I was afraid that something had been damaged or moved inside my body. But after the pain of my bruised muscles healed, I felt fine and am still humming along at age 78 in October!
Rudy is my husband and caregiver.
Thank you for your excellent presentation. I am a family practice PA in a remote area. With LVADs in more pts we all need to know as much as possible to best serve our communities and individual pts.
Great video thank you
Excellent Presentation.
Thanks for the video! Very well done
Excellent video. Thanks for taking the time to do this.
Heart Mate III patients can actually have a pulse and a BP! So, keep that in mind!
Thanks a million. It's an excellent, what's more, a way perfect presentation and explanation. Clearly understandable still very professional. Huge thanks!!!!!
Nice and simple. Thanks!
perfect ,presentation. Simple and completely understandable.
Many thanks
Fabulous ❤
Some LVAD patients will have pulses depending on patient and sometimes it will vary day to day in the same patient. pulse oximeters often work on them and to get a heart rate you can listen to the undulations of the pump as it loads and unloads with each heartbeat.
Awesome video about LVADS
Very helpful, thanks for putting this together!
Really helpful & quick soundbite :)
Thank you so much! Excellent presentation..
This was very informative, thanks! From a nursing student doing another dreaded care plan :)
Thanks Rahul, very well explained, excellent lectures!
Would be helpful to know if pt is breathing?
Thank you for replying quickly and GREAT video
Thanks
great video!
Excellent lecture thanks
Thanks for your help- IM intern here trying to get a better understanding of my cardiology patients. One question- why do LVAD puts you at increased risk of PE?
LVAD's are foreign objects place inside the body and they are thrombogenic, can cause platelet dysfunction thereby can cause coagulation problem
Good job. Thank you
Thank you so much
Thank you sir for explaining clearly
What about calibration for the LVAD??
We don't do calibration of the LVAD in the ER. That's best left to people who are more experienced with that equipment, the LVAD team. Thanks for your comment.
for heartware, take the patient's latest hematocrit for calibration. other facilities do the calibration if the hematocrit is +/- 5 from the previous values. u can checke ur facility's protocol.
Hi sir thank you. How much should we keep INR or APTT or act to avoid thrombus formation. How often should check the coagulation profile when the people are away from the hospital. Thank you.
Thank you from an MS4!
very cool! thanks
Very easy to understand! A few small questions:
How does the pump know when to increase supply (flow rate) to compensate for increased demand?
Impact on coronary artery supply?
Can you review the role of the drive line as I'm unclear how it can become infected? (I thought it was just a power and command centre supply to the pump)
when speed is increase, the flow increases. there is a differential pressure across the pump, the inlet (LV pressure) and outlet (Aortic pressure) need to have a decrease pressure difference for the pump to have an easier propelling to have an increase flow. the VAD parameters trends should be monitored to be able to trouble shoot the other causes of deviating to normal values of the VAD parameters. VAD, helps the already sick heart, with the pump functions assures blood supply to the body system including the heart - provided that other impending problems are attended (such as dehydration or low blood volume and arrhythmias that pump can trigger suction events)
Awesome
thank you for sharing this :)
What do you hear when taking the manual bp if there’s no pulsation? Also the early heartmates had an external device that we (nurses) would use instead of doing compression
Čuje se samo jedan treptaj i mora biti od 60 do 80
nice
I'm still little confuse with taking bp with Doppler. Thanks
LVAD bypasses the normal cardiac cycle, no korotkoff's sound will be appreciated with the use of stethoscope thereby doppler is use to take the target MAP of 65-75 mmHg (not the BP - no systolic/ diastolic readings)
Ok video, but you are misinforming people! The patient is going to be brain dead by the time you do all this troubleshooting if the LVAD is not functioning. If you do CPR, yes there is a chance you could dislodge parts and kill them further, but that is a risk, at least you may circulating blood. If you sit and do nothing and the LVAD is not functioning while you "troubleshoot" for twenty minutes the patient is definitely now brain dead. In other words, quickly troubleshoot other causes and start CPR!!!! Yes, for sure contact the LVAD center, but they can only do so much without being there, and yes listen to what they have to say as they are the experts! I understand that CPR is risky, but not doing CPR on a dead patient is just as...
Also you made no mention of actually assessing the patient for signs of poor circulation, such as cyanosis, slow cap refill, diaphoresis, etc...
Also please don't dumb down paramedics and make it sound like we won't have any of this figured out by the time the patient arrives at the hospital, it was especially insulting when "the patient comes through the door with paramedics" and you (assuming doctor) notice this pump, as if the paramedics are going to miss that fact! Please have more respect for EMS, we are not dumb!
+Patch Molly Thanks for your comments.
I apologize, I had no intention to insult paramedics. Paramedics do an amazing job in difficult conditions. You do the hard work, we have it easy in the hospital. I truly have the utmost respect for you and do not think paramedics are dumb. Please accept my apologies.
My videos are directed toward medical students, so the "dumbing down" you may have noticed is because of the lack of experience the students have compared to practicing clinicians (EMS, nurses, docs, etc).
When I made the video, the recommendation was to NOT start CPR on those with an LVAD due to the theoretical fear that dislodging the ventricular connection would cause the patient to exsanguinate immediately. Your points are well taken and now the recommendation, as you say, is the hail mary pass you have to take. There's a chance the patient will die with CPR, and a certainty they'll die without it. And the connections don't dislodge as often as thought.
I speculate this recommendation came from the fact that when LVAD's were new and unfamiliar, people would find a pulseless patient and immediately start CPR. A patient can be unresponsive from a myriad of reasons having nothing to do with poor cardiac output. For those with an LVAD, at least think of those first, before jumping reflexively into CPR.
Thanks of your comments.
+Rahul Patwari (Rahul's EM) Doc, I am a paramedic in NJ and I learned a tremendous amount about LVADs in these two videos. I think the previous commenter was pretty harsh because the videos weren't really intended toward pre-hospital medical professionals such as EMTs and Paramedics although the information was very valuable. Clearly paramedics would have done a comprehensive exam such as assessing for spontaneous (and adequate) breathing, attached the EKG, assessed for other indicators of poor circulation (skin color, temperature, texture, etc), check a blood glucose, etc. At any rate, thank you. I will be using these videos in my EMT refresher class this week when we discuss LVAD.
Hello @patch molly, i understand your feeling... the video was presented in a very short span so to emphasized things in detailed... not everyone in the medical field has the opportunity to see what an LVAD looks like... BLS is very important but since we have this kind of new devices, compression is not always be the answer. I have been in the medical field for 15 years, the books taught us the basics but the critical thinking in every situations are acquired by experience.
Nunca hablan de las bacterias 🦠 por que no están preparados para ello y jamás se les avisa a las personas 😢