The patient and their family are experts on this device. Listen to what they have to say about any problems with the LVAD. 5. FEEL: Feel the control unit. A hot control unit indicates the pump is working harder than it should and indicates a pump problem such as a thrombosis (clot) in the pump. The use of pulse and blood pressure to assess stability can be unreliable in an LVAD patient, even if they are very stable. 6. VITALS: Pulse: generally, you will be unable to feel a pulse. Pressure: you may or may not be able to obtain one, standard readings are unreliable and may vary from attempt to attempt. If NIBP machine can detect a blood pressure, adjust it to display Mean Arterial Pressure (MAP). This is a more reliable measure of perfusion and the calculation for MAP can overcome variations in standard readings. A MAP of 60-70 is normal. Pulse-oximetry: readings seem to be fairly accurate and consistent, according to data, despite the manufacturer stating that pulse oximetry often doesn’t work. Quantitative Continuous Waveform Capnography: This should remain accurate, as it relies on respiration, not Normal (printed) waveform shape with a normal respiratory rate and low CO2 readings (<30) can indicate low perfusion = poor pump function. Temperature: infection and sepsis are common, temperatures! 7.9 Process for Changes to the Statewide Treatment Protocols All changes (any addition, deletion, or any other type of amendment) to the Massachusetts Statewide Treatment Protocols require statewide dissemination and often require training of EMTs and Medical Control physicians prior to implementation. Therefore, to ensure a thorough review and orderly implementation, all protocol changes shall be approved and implemented on an ANNUAL basis, with the exception of those arising out of procedures described in Part B below. Any protocol change must be approved pursuant to the following procedures. PART A Procedures for ANNUAL Protocol Changes 1. All requests for protocol changes shall be submitted by at least one Regional Medical Director to the Medical Services subcommittee by October 1 of the preceding year. The request for a protocol change shall include the following: a. A detailed description of the proposed change;
The patient and their family are experts on this device. Listen to what they have to say about any problems with the LVAD. 5. FEEL: Feel the control unit. A hot control unit indicates the pump is working harder than it should and indicates a pump problem such as a thrombosis (clot) in the pump. The use of pulse and blood pressure to assess stability can be unreliable in an LVAD patient, even if they are very stable. 6. VITALS: Pulse: generally, you will be unable to feel a pulse. Pressure: you may or may not be able to obtain one, standard readings are unreliable and may vary from attempt to attempt. If NIBP machine can detect a blood pressure, adjust it to display Mean Arterial Pressure (MAP). This is a more reliable measure of perfusion and the calculation for MAP can overcome variations in standard readings. A MAP of 60-70 is normal. Pulse-oximetry: readings seem to be fairly accurate and consistent, according to data, despite the manufacturer stating that pulse oximetry often doesn’t work. Quantitative Continuous Waveform Capnography: This should remain accurate, as it relies on respiration, not Normal (printed) waveform shape with a normal respiratory rate and low CO2 readings (<30) can indicate low perfusion = poor pump function. Temperature: infection and sepsis are common, temperatures! 7.9 Process for Changes to the Statewide Treatment Protocols All changes (any addition, deletion, or any other type of amendment) to the Massachusetts Statewide Treatment Protocols require statewide dissemination and often require training of EMTs and Medical Control physicians prior to implementation. Therefore, to ensure a thorough review and orderly implementation, all protocol changes shall be approved and implemented on an ANNUAL basis, with the exception of those arising out of procedures described in Part B below. Any protocol change must be approved pursuant to the following procedures. PART A Procedures for ANNUAL Protocol Changes 1. All requests for protocol changes shall be submitted by at least one Regional Medical Director to the Medical Services subcommittee by October 1 of the preceding year. The request for a protocol change shall include the following: a. A detailed description of the proposed change;
treatment-protocols-2018.docx