That registration process is a pain... I just tried to do it, and apparently they manually-approve each applicant. And it's a weekend, and... lol!
If it helps: During my EMS training on the Heartmate products (Thoratec) about a year ago, we needed to be aware of not only the newer line (Heartmate II), but we also have patients in our area with the older Heartmate I and other devices.
There's a lot of information to absorb, but some key Golden Rules that might help you with these LVADs:
1. There will be no pulses and no blood pressures you can obtain by a standard cuff... just listen for the thrill from the pump whirring, the patient's skin color, etc. The alarms on these devices are important, and the patient's family or his "Go!" pack should have a reference card for them. The families and patients in our area are HIGHLY trained on the pumps, what to expect, what constitutes a problem, and what needs to be made immediately available (such as the "go" bag or pack that includes a full set of charged batteries, reference cards, etc.). Please listen to these trained family members; they are INVALUABLE.
2. If the pump is not working and the patient is not responsive to stimuli, we immediately go to chest compressions on the Heartmate II device (which is allowed because 'dead is dead' if we do nothing; careful on correct hand placement to prevent dislodging the device). On the older devices, there is a handle of sorts we attach to provide manual flow, so you don't do compressions directly that would damage the device (as mentioned by classicdame).
3. Preload and afterload is very important for these patients in our pre-hospital setting, as these pumps need something to work with. We avoid nitroglycerin, morphine, furosemide, and other potentially vasodilative or diuretic medications, and leave those treatment decisions to the receiving hospital. Otherwise, we continue with cardiac monitoring, IV establishment, oxygen, diesel bolus (ambulance, not IVP
), etc. as needed.
4. We do not give aspirin in the field. These patients are already anticoagulated well with home medications that prevent any clots from forming in these pumps.
5. Defibrillation/cardioversion is permitted if needed. It's very strange to have a patient in V-fib talking to you and only reporting weakness and dizziness. In this case, the blood is still being pumped by the device to the brain, but the heart's dysrhythmia must be treated.
I'm sure there's a ton of information for in-hospital care and would really love to hear that end of it too (hint, hint), but thought I'd offer some treatment pearls from the EMS side.
Hope it helps.