PV Card: LVAD Complications

Patients with left ventricular assist devices (LVAD) often cause much anxiety amongst providers in the emergency department. This is understandable with all of the hardware, diminished or absent peripheral pulses at baseline, and potential for complications. To add to the already helpful reviews about LVADs at REBELEM and emDocs, this is a PV card set providing a methodical approach to troubleshooting LVAD complications, including a reproduction of an algorithm for managing the LVAD patient with altered mental status from EMCrit.^1–3

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EXPERT PEER REVIEW: LVAD Complications

John Greenwood, MD
Assistant Professor
Department of Emergency Medicine
Department of Anesthesiology and Critical Care
Hospital of the University of Pennsylvania | Perelman SOM

Overall, a very well written summary for the ED provider faced with the challenge of managing the patient with an LVAD. These patients can be very complex, where the clinician may need to address a range of potential problems that can include hemodynamic complications, coagulopathy & bleeding, arrhythmias, and infection. After you initially assess the patient, the most important step is to task someone to get a hold of the VAD coordinator as they will often be able to guide you through any recent device changes and previous complications. The patient’s family can provide a wealth of information – use them! Knowing the most common complications will help guide your HPI, exam, and interventions so that you are well prepared for the next time a VAD patient presents to your ED.

Thumbnail LVAD image use approved by Mayo Foundation for Medical Education and Research

References

Partyka C, Taylor B. Review article: ventricular assist devices in the emergency department. Emerg Med Australas. 2014;26(2):104-112. [PubMed]
Andersen M, Videbaek R, Boesgaard S, Sander K, Hansen P, Gustafsson F. Incidence of ventricular arrhythmias in patients on long-term support with a continuous-flow assist device (HeartMate II). J Heart Lung Transplant. 2009;28(7):733-735. [PubMed]
Greenwood J, Herr D. Mechanical circulatory support. Emerg Med Clin North Am. 2014;32(4):851-869. [PubMed]

By Nicolas Stadlberger, MD|2021-10-02T19:11:24-07:00Nov 23, 2016|ALiEM Cards, Cardiovascular, Critical Care/ Resus, Expert Peer Reviewed (Clinical)|

PV Card: Knee Injuries | Quick Reference Guide

Orthopedic injuries are commonly managed in the emergency department. Often a quick bedside reference card is needed to remind the clinician about the acute management decisions. This is the third of a series of orthopedic quick reference cards written by a team from the 2015-16 ALiEM Chief Resident Incubator. The first two were on ankle and hindfoot fractures and hip injuries. This card set covers knee injuries, specifically patella fractures, patella dislocation, and knee dislocation. These cards were expert reviewed by Dr. Scott Sherman, co-editor of the Emergency Orthopedics textbook (Amazon), and illustrations were created by Dr. Mary Haas.
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By Layla Abubshait, MD|2021-10-19T18:58:50-07:00Nov 21, 2016|ALiEM Cards, Orthopedic|

PV Card: Hip Injuries | Quick Reference Guide

Orthopedic injuries are commonly managed in the emergency department. Often a quick bedside reference card is needed to remind the clinician about the acute management decisions. This is the second of a series of orthopedic quick reference cards written by a team from the 2015-16 ALiEM Chief Resident Incubator. The first was on ankle and hindfoot fractures, and this card set covers hip injuries, such as hip dislocations and femur fractures. These cards were expert reviewed by Dr. Scott Sherman, co-editor of the Emergency Orthopedics textbook (Amazon), and illustrations were created by Dr. Mary Haas.

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By Layla Abubshait, MD|2021-10-04T09:29:28-07:00Nov 14, 2016|ALiEM Cards, Orthopedic|

PV Card: Algorithm for acute bronchiolitis management

Bronchiolitis is a common lower respiratory tract infection in children less than 2 years old, and especially in those 3-6 months old. In a collaboration with the American Academy of Pediatrics’ (AAP) Section on Emergency Medicine Committee on Quality Transformation, we present a PV card summarizing the Section’s “Clinical Algorithm for Bronchiolitis in the Emergency Department Setting” (reproduced with permission).¹ Dr. Shabnam Jain sums it up best in her expert peer review below: “In bronchiolitis, less is more.”
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By Michelle Lin, MD|2021-10-04T09:31:54-07:00Nov 7, 2016|ALiEM Cards, Expert Peer Reviewed (Clinical), Pediatrics, Pulmonary|

Magnesium for Rapid Atrial Fibrillation Rate-Control in the ED

We love magnesium in the Emergency Department. It’s been said that magnesium is second-line for everything (kind of like doxycycline). But what about rate/rhythm control in atrial fibrillation (AF)? The 2014 AHA/ACC/HRS guideline for the management of patients with AF doesn’t mention magnesium at all.¹ Dr. Josh Farkas (@PulmCrit) wrote about magnesium infusions for atrial fibrillation and torsade last year. His post looked at its use for cardioversion, rhythm-control, and rate-control in critically-ill patients. Our post will focus specifically on the IV magnesium data for rate-control in ED-related settings.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2018-08-22T06:55:46-07:00Oct 26, 2016|Cardiovascular, Tox & Medications|

Whipped Cream Charger Abuse: The Toxicologist Mindset

The Toxicologist Mindset series features real-life cases from the San Francisco Division of the California Poison Control System.

Case: A 39-year-old man, with no significant past medical history, was brought to the emergency department by family members, over three consecutive days, for anxiety, confusion, and ataxia. In the first two visits, his laboratory work-up, including complete blood cell count, chemistry panel, liver function tests, urine drug screen, and non-contrast head CT, were unremarkable. On his third visit, he was profoundly encephalopathic with confusion and poor concentration. He had bilateral lower extremity weakness and ataxia. He was admitted to the neurology service for further work up. Additional history revealed that hundreds of empty canisters of whipped cream chargers were found in his house.

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By Kathy Vo, MD|2016-11-11T19:47:20-08:00Oct 17, 2016|Tox & Medications|

ALiEMU CAPSULES Module 7: Emergency Thyroid Disorders

We are proud to present CAPSULES module 7: Emergency Thyroid Disorders, now published on ALiEMU. Here is a summary of the key points from this outstanding module by Drs. Craig Cocchio and Colleen Martin.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2019-02-19T18:24:36-08:00Oct 10, 2016|Capsules, Endocrine-Metabolic, Tox & Medications|