Assess perfusion and general state (mental status, skin temp/color, capillary refill, etc)
LVADs are preload dependant - if symptoms of hypoperfusion, give fluid blous
HR measured via ECG or auscultation (may be difficult secondary to pump noise)
Get 12-lead ECG on all LVAD patients
Demonstrates primary cardiac disease
Generally, VAD does not influence underlying cardiac rhythm
Imaging:
Bedside echo if able, formal echo if available, with the following suggestive of thrombosis:
Cannula flow velocity > 2 m/s
More frequent opening of aortic valve than at baseline
Increasing LV internal dimension in diastole without manual speed changes
CT with contrast to look for thrombus, discuss with radiologist to protocol
Blood pressure measured with manual BP cuff and Doppler ultrasound - MAP is identified when constant flow is heard
MAP should be 65-80 mmHg
Can also monitor with arterial line
Basic lab should be obtained on all LVAD patients
Cardiac labs - BNP, troponin
Include thrombolysis, coagulopathy labs
CBC
CMP, indirect bilirubin
PT/INT/PTT
LDH
Haptoglobin
Fibrinogen
UA for hematuria
Quantitative plasma free hemoglobin
Consider TEG
LDH elevation over 1,150 IU/L suggestive of pump thrombosis
Approximate sensitivity of ~80% and specificity of 90%
Hemolysis within thrombosed pump releases LDH
Assess LVAD status
Auscultate for pump noise<unk>  parameters (found on controller)
Pump speed - varies by<unk>  - 2,000-10,000 RPM
Power - normal 4-6 Watts
Flow - normal 4-6 L/min
Pulsatility Index (PI) - normal 1-10
Measures magnitude of pulsatile flow provided by native cardiac contractions
Higher PI = less LVAD support
Clinical status more important than LVAD parameters
If hypotension, consider VAD flows
Low VAD flow
Low JVP - bleeding, hypovolemia
High JVP - RV dysfunction, inadequate unloading, PE, PTX, tamponade
High VAD flows - vasodilatation (sepsis, vasoactive medications)
LVADs are preload dependant - if symptoms of hypoperfusion, give fluid blous
Demonstrates primary cardiac disease
Generally, VAD does not influence underlying cardiac rhythm
Bedside echo if able, formal echo if available, with the following suggestive of thrombosis:
Cannula flow velocity > 2 m/s
More frequent opening of aortic valve than at baseline
Increasing LV internal dimension in diastole without manual speed changes
CT with contrast to look for thrombus, discuss with radiologist to protocol
Cannula flow velocity > 2 m/s
More frequent opening of aortic valve than at baseline
Increasing LV internal dimension in diastole without manual speed changes
MAP should be 65-80 mmHg
Can also monitor with arterial line
CBC
CMP, indirect bilirubin
PT/INT/PTT
LDH
Haptoglobin
Fibrinogen
UA for hematuria
Quantitative plasma free hemoglobin
Consider TEG
Approximate sensitivity of ~80% and specificity of 90%
Hemolysis within thrombosed pump releases LDH
Auscultate for pump noise<unk>  parameters (found on controller)
Pump speed - varies by<unk>  - 2,000-10,000 RPM
Power - normal 4-6 Watts
Flow - normal 4-6 L/min
Pulsatility Index (PI) - normal 1-10
Measures magnitude of pulsatile flow provided by native cardiac contractions
Higher PI = less LVAD support
Clinical status more important than LVAD parameters
If hypotension, consider VAD flows
Low VAD flow
Low JVP - bleeding, hypovolemia
High JVP - RV dysfunction, inadequate unloading, PE, PTX, tamponade
High VAD flows - vasodilatation (sepsis, vasoactive medications)
Pump speed - varies by<unk>  - 2,000-10,000 RPM
Power - normal 4-6 Watts
Flow - normal 4-6 L/min
Pulsatility Index (PI) - normal 1-10
Measures magnitude of pulsatile flow provided by native cardiac contractions
Higher PI = less LVAD support
Measures magnitude of pulsatile flow provided by native cardiac contractions
Higher PI = less LVAD support
Low VAD flow
Low JVP - bleeding, hypovolemia
High JVP - RV dysfunction, inadequate unloading, PE, PTX, tamponade
High VAD flows - vasodilatation (sepsis, vasoactive medications)
Low JVP - bleeding, hypovolemia
High JVP - RV dysfunction, inadequate unloading, PE, PTX, tamponade
Left ventricular assist device complications
Bleeding - most common reason for ED visit, most common in first month after implant 
Heart transplant complications
GI bleeding is the most common source 
Aortic endograft complications
Mechanisms:
Cardiac ablation complications
Acquired Von Willebrand Disease 