A 66-year-old man with an LVAD arrives as triage level 1 with confusion after vomiting. No palpable pulse is detected, but Doppler MAP is 48 mm Hg,

Question

A 66-year-old man with an LVAD arrives as triage level 1 with confusion after vomiting. No palpable pulse is detected, but Doppler MAP is 48 mm Hg, capillary refill is delayed, and the controller alarms low flow. Bedside ultrasound shows a collapsed inferior vena cava. Which of the following is the most appropriate initial action?

Accepted Answer

Assess LVAD connections and start cautious crystalloid resuscitation while contacting the VAD team

Answer

Disconnect the driveline to reset the pump

Answer

Administer IV furosemide for suspected pump overload

Answer

Begin chest compressions solely because a pulse is absent

Answer

Discharge after controller alarm silence

LVAD low-flow shock — ABEM Board MCQ