Abiomed‘s Impella left ventricular assist device, an endovascular percutaneously-delivered LVAD, will soon be getting a more powerful new model. The current model is capable of delivering an augmentation of cardiac output by up to 2.5 liters a minute, but the new Impella cVAD should do around 3.5 L/m, and possibly up to 4 L/m in the not too distant future.
The new device, and above numbers, were announced at Abiomed’s investor day conference and the company hopes to have the device available to clinicians by the Summer of 2012.
Here are the bullet points about Impella cVAD that were provided to us by Abiomed: Read more »
*This blog post was originally published at Medgadget*
Tomorrow we’ll be far away
Tomorrow is the judgement day
Tomorrow we’ll discover what our God in heaven has in store
One more dawn…
On an unrelated note, tomorrow morning at 5AM our new ER opens and the old one closes down. I’ll be there working clinically. To the degree that it doesn’t interfere with patient care, I’ll live-tweet the experience.
For those not familiar with the institution or the project — it’s a 110,000 annual visit ER closing down and reopening next door in a new, state of the art 83 bed ER, with an entire new 10-story hospital opening directly above at the same time, more or less. The logistics of the transition are pretty staggering. The ER will be the first unit to open. The old ambulance bay will have a barrier put up at 5AM and the new department’s ambulance bay and drop-off will be illuminated at that time and all new patients will go there. The staff closing out the old shop will dispo all the patients they can, and at a certain point, maybe by ten AM, any patients still in the old ER will roll across the skybridge to the new facility. We will open one cath lab and one OR in the new hospital while retaining capability at the old rooms. New patients admitted will go to the new tower and the old inpatient units will start discharging patients. By Friday, any patients still in the old tower will move across to the new inpatient units. They’ll be bringing the other ORs and interventional labs online in a stepwise fashion during the week. Interestingly, a lot of expensive equipment is being “salvaged” from the old hospital. For example, the telemetry monitors in the ICU — about half of the new ICU beds have monitors now. When a patient is discharged from the old ICU, they will take that monitor across to the new building and install it in a new ICU bed, which will only then become open for a new patient. Eventually, all the monitors will be re-installed in the new units. Elective surgeries are pretty much out this week. When everything is open we will have 16 ORs and 8 cath/vascular/EP labs with room for four more as need demands.
For the ER (and more importantly for ER patients) this will be Read more »
*This blog post was originally published at Movin' Meat*
Seen it a hundred times.
Old guy (or gal).
Comes into ER.
“Hey doc, looks like his hearts goin’ slow. I think he (or she) needs a pacer.”
“On any meds that might do this?”
“How’s his (her) potassium?”
And like lots of times, you head in. Glad you can help. Call-team’s on their way, thanks to you. Called the device rep to make sure they can be there just in case, too. Cool as a cucumber. Nothin’ to it. Been here, done this.
You arrive to a guy (or gal) that looks pretty good. Maybe has one or two medical problems. Heart rate’s better thanks to the atropine and the fluids they gave him (her) on arrival. The intraosseus line in the tibia is impressive, too. (“At least he (she) wasn’t awake when that happened,” you think.)
So you review, examine, plan your approach. EKG on presentation? Ouch, heart rate agonal. Wide complex rhythm of right bundle branch rhythm. Look at the monitor: “lots more right bundle branch rhythm there, thank goodness, P waves, too.” you secretely notice.
Seems he (or she) is willing (how many times does he (or she) want to pass out at home?), understands what lies ahead, that the crew’s on their way. “We’ll be taking you over in just a few minutes. Any other questions?” There are none.
And after a while the crew arrives, assembles the poor guy (or gal) on the table and ships him (or her) over to the cath lab area. Chest is prepped, equipment assembled, antibiotics given, monitors connected…
… damn we’re good. Smooth operators.
So the local anesthetic is injected and the incisions made. Dissection to the pre-pectoralis fascia just above the breast muscle accomplished, even the wires passed easily into the vein using ultrasound guidance. Even having a nice chat with the guy (or gal).
Poetry in motion.
Sheaths placed in the vein over the guidewire, pacing leads placed through the sheath. Until, from the control room… Read more »
*This blog post was originally published at Dr. Wes*
Ready to learn more about nurses who work beyond the bedside? Nurses who work in the Cardiac Catheterization Lab (CCL) play an important role in cardiac care. Amy Sellers, RN BSN CCRN CSC CMC blogs at Nursing Influence and graciously agreed to give us a peek at what a nurse is responsible for doing in the CCL.
Amy has worked in the Cath Lab for about 6 months now. She previously worked in CVICU for almost 5 years before deciding that she needed a new challenge. She is paid hourly and works three 12 hour shifts per week (all daytime Mon-Fri) with lots of opportunities for overtime and call shifts.
A cath lab is an area of the hospital that uses fluoroscopy and contrast dye to check for narrowing/blockages in arteries or veins in the body. Using special equipment, they are able to perform angioplasty (open the arteries with a balloon), place stents, insert IVC filters (a filter that is inserted into a large vein which prevents blood clots that form in the leg from getting to the lungs) as well as inserting pacemakers/ICDs. ICDs are Implantable Cardiac Defibrillators. They detect if a patient’s heart goes into a lethal rhythm and provides a shock to the heart if necessary to get it beating correctly again.
What do you do all day? Read more »
*This blog post was originally published at code blog - tales of a nurse*
I sent a guy with a normal EKG to the cath lab. Let me tell you my side of the story.
Dude was minding his own business when he started having crushing, substernal chest pain. I see dude by EMS about 45 minutes into his chest pain. He’s had the usual: aspirin, 3 SL NTG’s an IV, a touch of MS (I can abbreviate here, as it’s not a medical record) and is continuing to have pain.
He describes it like you’d expect (elephants have a bad rep in the ED), and looks ill. Frankly, he looks like a guy having an MI. Sweaty, pale, uncomfortable, restless but not that ‘I’ve torn my aorta’ look. The having an MI look.
Every EM doc knows the look. I didn’t ask about risk factors.
On to the proof: the EKG. EMS EKG: normal. ?What? Yeah, maybe there’s some anterior J-point elevation, but not much else. Our EKG: Normal. Read more »
*This blog post was originally published at GruntDoc*