Original Publication
Open Access

Emergency Department Management of a Multiple Trauma Patient With a Left Ventricular Assist Device

Published: December 22, 2014 | 10.15766/mep_2374-8265.9984

Included in this publication:

  • LVAD Instructor's Guide.docx
  • LVAD Presentation.ppt
  • LVAD Handout.docx
  • LVAD Sim Case.docx
  • LVAD Debriefing Questions.docx
  • LVAD Modified Standardized Direct Observational Tool.doc
  • LVAD Pocket Reference Guide.docx
  • LVAD Visual Stimuli.docx
  • LVAD CXR.JPG

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.


Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.

Abstract

Introduction: Patients with a left ventricular assist device (LVAD) can be difficult to assess as most do not have a measurable blood pressure, pulse, or oxygen saturation. Instead, assessment relies on mental status and Doppler. Often these patients are on anticoagulation and can have significant bleeding during trauma. Methods: During this simulation case, a 79-year-old male is brought in to the Emergency Department via Emergency Medical Services after being involved in a motor vehicle collision. The patient is noted to have an LVAD in place. The physician will need to manage the patient as a typical trauma, while considering any complications that can develop secondary to having an LVAD. Results: Three residents separately participated in this simulation case. All three participants effectively managed the trauma aspect of this simulation while managing all complications provided by an LVAD. They stated that it was an effective learning case and all three met all educational objectives. Discussion: This simulation case can be effectively used to train residents and physicians on the special considerations associated with an LVAD during a trauma. Participants suggested this case be used for residency level two or higher.


Educational Objectives

By the end of this session, learners will be able to:

  1. List the special considerations that need to be addressed when providing emergency care to a patient with an LVAD.
  2. Recall the need for Doppler and manual blood pressure (bp) cuff in order to obtain Mean Arterial Pressure (MAP).
  3. Explain when you should or should not initiate chest compressions in an LVAD patient.
  4. Describe how to assess for bp using Doppler and physical exam findings, such as mental status and capillary refill.
  5. Demonstrate appropriate assessment of vital signs in an LVAD patient.
  6. Recognize need to call LVAD coordinator.
  7. Examine LVAD equipment for alarms, signs of trauma (broken wires, hardware damage, kinked lines), and auscultate the patient’s chest for an audible hum.
  8. Demonstrate appropriate interaction with Medical Control prior to patient’s arrival.
  9. Demonstrate proficient application of the Primary Survey for Trauma.
  10. Demonstrate proficient application of the Secondary Survey for Trauma.
  11. Demonstrate focused history from all needed sources including AMPLE history.
  12. Demonstrate good team management skills.
  13. Demonstrate rapid, appropriate therapeutic interventions.
  14. Demonstrate close patient monitoring with frequent reassessment.
  15. Manage hemorrhage secondary to anticoagulant use in an LVAD patient involved in trauma.
  16. Create a treatment plan for hemorrhaging trauma LVAD patient.
  17. Reevaluate patient for response to intravenous (IV) fluids and blood products.
  18. Assess need for immediate surgical consultation with a Focused Assessment with Sonography for Trauma (FAST) exam.
  19. Illustrate timely disposition.

Author Information

  • Jessica Rando, MD: Wright State University Boonshoft School of Medicine
  • Alexander Bedard, MD: Wright State University Boonshoft School of Medicine
  • Raymond Ten Eyck, MD: Wright State University Boonshoft School of Medicine

Disclosures
None to report.

Funding/Support
None to report.



Citation

Rando J, Bedard A, Ten Eyck R. Emergency department management of a multiple trauma patient with a left ventricular assist device. MedEdPORTAL. 2014;10:9984. https://doi.org/10.15766/mep_2374-8265.9984