Categories
CVS - Clinical/Cardiology Surgery

How Does the Impella Ventricular Assist Device Work?

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Impella is a ventricular assist device, that is FDA approved for short-term support of the left ventricle. There is also a version that can be used for the right ventricle as well. The device can support 2.5 to 5 L/min of blood flow, the latter of which is considered a normal cardiac output.

The device is minimally invasive and catheter-based, so it is usually placed by Interventional Cardiologists in the catheterization laboratory. It is an impeller driven, axial-flow pump (which derives its inspiration from the Archimedes pump from antiquity).

The device is positioned so that the intake of the pump sits in the LV cavity and the outflow in the aorta, just above the aortic valve. In this way, the pump replaces the work done by the left ventricle and sucks up the oxygenated blood as it returns from the left atrium and forcibly delivers it into the aortic root (beginning part of the aorta).

The oxygenated blood then feeds the coronary arteries and the rest of the body. By removing the blood from the LV cavity, the device reduces pre-load, and by ejecting it at a high velocity into the aorta, it reduces afterload. This has the net effect of “unloading” the left ventricle and thereby reducing the energy required by the LV to function. This, then, rests the LV and allows it to recover as the LVAD does the heart’s work. An impella placed in the RV works by the same principles, to help right ventricular function.

 

Impella Videos :

https://www.youtube.com/watch?v=ZgqKwG2HaxQ

https://www.youtube.com/watch?v=A0q64bXxDQY

https://www.youtube.com/watch?v=GhWB7T5QxMI

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    Categories
    Surgery

    Question: surgery case – ID SUR1001

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    64 y F with Hx of emphysema, HTN, laparoscopic hemicolectomy for Stage 2 colorectal cancer, and femoral hernia who presents with cramping abdominal pain, nausea, and vomiting. Her last bowel movement was yesterday morning. On exam, she has a distended abdomen with mild diffuse tenderness without rebound or guarding. She has a lump in her left groin which is reducible and non-tender.

    Vitals: T 37.2C, HR 98, BP 138/74, SpO2 93%.

    Her WBC is 10.1, Hb 11.4, BUN 39, Cr 1.1, LFTs normal. CT Abdomen / Pelvis shows dilated loops of small bowel with a transition point.

     

    What is the appropriate management?

    A) OR for exploratory laparotomy

    B) Admit, make NPO and place an NGT to low continuous suction

    C) OR for reduction and repair of a femoral hernia

    D) Admit, make NPO and do not place an NGT

    E) Admit and start a bowel regimen and give the patient an enema

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    Categories
    Microbiology Pharmacology Surgery

    Treatment of Methicillin Resistant S. Aureus Bacteremia

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    Disclaimer: this is not a prescription. Using medicines without the guidance of a licensed provider  can be lethal.

    This is not a prescription for any specific patient. For methicillin RESISTANT (MRSA) staphylococci following antimicrobial therapy can be used:

    Vancomycin 15-20mg/kg IV every 8 to 12 hours. Not to exceed 2 g per dose. Or Daptomycin 6-10 mg/kg IV once daily.

    Alternative agents can be:

    Ceftaroline 600 mg IV every 12 hours

    Telavancin 10 mg/kg IV once daily

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    Categories
    Microbiology Pharmacology Surgery

    Treatment of Methicillin Sensitive S.Aureus Bacteremia

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    Disclaimer:

    This is not a prescription. Using medicines without the guidance of a licensed provider  can be lethal

    This is not a prescription for any specific patient.

    For methicillin sensitive staphylococci following antimicrobial therapy can be used:

    1.  Nafcillin 2g IV every 4h. Or
    2.  Oxacillin 2g IV every 4h. Or
    3.  Flucloxacillin 2g IV every 6h.

    If the pathogens are penicillin sensitive then penicillin 4 million units IV every 4h is the drug of choice. Keep in mind that mostly the isolates are not penicillin sensitive.

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