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The National Lecture Series - The 6 Million Dollar Patient - Part1 - LVAD’s

Anand Swaminathan, MD FAAEM, Dan Egan, MD FAAEM, and Haney Mallemat, MD FAAEM
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Nurses Edition Commentary

Mel Herbert, MD MBBS FAAEM, Lisa Chavez, RN, and Kathy Garvin, RN
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02:04

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EM:RAP 2014 October - Summary 1 MB - PDF

Do you like Lee Majors and the idea of being better, stronger and faster!  Well you will love this segment on implanted devices...but sadly you will  still not be able to run at 80 miles and hour!

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Derek I., M.D. -

One thing I did not agree on was doing CPR if the patient is in cardiac arrest.

Let's look at this from 2 sides: the LVAD doesn't work or the heart doesn't work
1) LVAD doesn't work: unless you have a CT surgeon at the bedside, you cannot fix this patient
2) Heart doesn't work but LVAD does
These patients are so sick that the basically have an artificial LV. If the heat stops, there is nothing we can do to get them back

Let's get real-cardiac arrest in a LVAD patient without VF/VT equals deaht.

Anand S., M.D. -

Derek - I understand your reluctance but take a peak at the article from Shinar http://www.ncbi.nlm.nih.gov/pubmed/24472494

In this retrospective case series, 4/8 patients who had compressions had a good neuro outcome. The game is not over if these patients arrest and I don't think you can stand there and do nothing.

James C. -

Anyone know how/if LVADs change the ECG? A brief Google search found that only the QT was primarily effected, but only after time. Is a STEMI still and STEMI with LVADs? (and do we really even care if there is a STEMI?)

Haney M. -

Great question....the ECG can vary widely in patients with LVADs and I'm not aware of anything that is specific for an ECG with LVADs patients. Generally the heart's electrical activity is intact and the pump is working independent of that. In patients w/ LVADs secondary to severe cardiac disease you may expect to see all the typical things associated with that (Q waves, inverted T's, etc.), but that was likely present prior to LVADs. STEMI should still be a STEMI and you should care especially if right sided MI is at play. LVADs only affect the LV function, but you still need a good RV to push the blood to the LV. That being said, probably best to know if an LV MI is present (although little my be done acutely) since the LV has failed.

Great question...thanks!

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Episode 157 Full episode audio for MD edition 270:45 min - 377 MB - M4AEM:RAP 2014 October Canadian Edition Canadian 21:52 min - 30 MB - MP3EM:RAP 2014 Octobre Résumé en Francais Français 72:52 min - 100 MB - MP3EM:RAP 2014 October Aussie Edition Australian 29:01 min - 40 MB - MP3EM:RAP 2014 Octubre Resumen Español Español 95:26 min - 131 MB - MP3EM:RAP 2014 October MP3 342 MB - ZIPEM:RAP 2014 October - Summary 1 MB - PDFEM:RAP 2014 October Board Review Questions 652 KB - PDFEM:RAP 2014 October Board Review Answers 424 KB - PDF

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