PATIENT'S DETAILS
| Patient name | |
| Date | |
| Time | |
VAD FINDINGS
| Energy level - Watt | - - - - - 9 - - - |
| Assistance level | - - |
| Drive line sttus | Cable pictures |
CLINICAL DATA
| Temperature (°C) | |
| Systemic pressure (mmHg) | |
| Heart rate (beats/minute) | |
| Body weight (Kg) | |
| Oedemas | - - |
| Diuresis (ml/day) | |
LABORATORY AND INSTRUMENTAL DATA
| Haemoglobin (g/dl) | |
| Lactate dehydrogenase (LDH)( IU/L) | |
| Total bilirubin (mg/dl) | |
| Direct bilirubin (mg/dl) | |
| Haptoglobin (mg/dl) | |
| Reticulocytes (%) | |
| Partial thromboplastin time (PTT) | |
| Leucocytes (WBC) n/ml | |
| Platelets (PLT) n/ml | |
| International nornalizes ratio (INR) | |
| Creatinine (mg/dl) | |
| Electrocardiogram (ECG) | picture of electrocardiographic tracing |
| Echocardiography (TTE/TEE) | pictures or images |
| Chest radiography (Chest XR) X-rays | picture of X-rays |
| Brain CT scan | |
| Chest CT scan | |
THERAPY
| ACE inhibitors | ||
| Beta-blockers | ||
| Inotropes | ||
| Diuretics | ||
| Anti-aggregants | ||
| Heparin | ||
| Oral anticoagulants | ||
NOTES
