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Went to an all day seminar a couple weeks ago about LVAD's. Turns out we have a couple patients in our area on the devices and I wanted to become more familiar with them. Amazing stuff. Learned a lot, and the future is even brighter. The latest model, still in clinical trials but implanted in patients in Germany, is about the size of a hockey puck and is completely implanted within the chest. Some of the devices are temporary while awaiting a transplant, while others are destination devices, designed for people who are not transplant candidates. Take away points- Use the LVAD coordinator, who is always assigned to LVAD patients. The patient/family/caregiver will have the number of this person and they are a great resource. They are familiar with the patient as well as the device and are more than happy to assist. No CPR. These devices supplement or completely take over the heart's pumping, so compressions aren't really necessary. As was noted, compressions will probably damage the hoses. These devices are attached by boring a hole directly in the heart muscle and if the hoses are torn, the person will bleed out. Also, any problems you see will be from the patient, not the device, so treat the patient. In the unlikely event of a pump/battery failure, some models also have manual devices which fit over the hoses to take over the pumping, and essentially look like esophageal detector devices used to confirm ET placement. Vitals signs are also different- a lower systolic pressure is actually desirable- higher BP's and it may cause problems. Probably the most interesting- and strange- a person may be in Vtach or Vfib. Unless they are symptomatic, immediate defibrillation or cardioversion may not be needed, especially if the person is conscious and awake. Take time, evaluate the person and their complaints and discuss with the LVAD coordinator and your medical control as to what you should do. Since they will be perfusing regardless of their rhythm, you have time to take a step back and see what other problems may need to be addressed- hypovolemia, electrolyte imbalances, fluid retention, etc . Also, bring ALL the equipment with the patient- including back up devices and spare batteries. There's more, but these are probably the biggies. Fascinating devices, and truly life savers for people. We met 6 people who had these devices, one for nearly 5 years. They can lead relatively normal lives when before getting out of a chair was a struggle. One guy has traveled all over the world since having hi LVAd implanted 2 years ago, I'm certainly no expert in LVAD's but at least I have a familiarity with these devices now.

In Germany the most effective ingredients of such energy drinks are caffeine, sugar and marketing. I didn't find niacin on the list, at least for the brand with the bull. Caffeine and sugar sure will give you some fast "energy" as well as the 480 kJ per 250ml can will add significant to your daily body mass balance. But the real magic comes from the marketing effect, I think. However, I must say, that I tested such a drink only once (one mouth full) and spit it away. It simply tasted awful sweet and didn't meet my criteria for a drink - and I'm a passionate drinker of cola (since a few years: diet coke). Compared to other colleagues and especially to younger ones with a significant use of "energy drinks" I can't see a better outcome of them on long moonlight rides and overtime shifts or even at excessive bar nights. Most times I outrun them...without coffee, just with diet coke (except for the excessive bar nights, we use other drinks then, you can imagine). So I hold the marketing department of those companies more responsible for any real effects than the chemical branch. And at least for the German market's product ingredients, I can't see any special bad influence on health other than the usual problems with unhealthy living (caffeine, sugar, minimal sleep, excessive bar nights). I can't see any special benefit in drinking this stuff, too.

Thanks for the responses guys. Glad to see I knew what I was talking about and not just thinking out my ass. Guess this Basic knows a few things