Too bad, so sad … it’s friday afternoon with a VAD

The case It's a Friday afternoon; you are tired and ready for a much deserved weekend retreat. You have been working the GI suites all day and have been as efficient as you could be to get done early and have a head start on your weekend. Just as you finish your last case, you start creeping toward the door, when you notice another patient in the preoperative area. You question the administrative assistant, and she says that it is a last-minute add-on and that she knows nothing about the patient, except that he is scheduled for a percutaneous endoscopic gastrostomy/jejunostomy(PEG/J) tube placement. You curse, put down your bag, and proceed to rummage through the various stacks of paper work, looking for the patient's chart. There are a couple of papers bound with a paper clip that represent the “extensive” chart available on this patient. As you approach the patient, you notice a peculiar looking device at the side of the bed with various digital readings. On further evaluation, you notice the word THORATEC etched across the machine, and your worst fears are realized – this patient has a ventricular assist device (VAD). The patient is a 55-year-old who appears awake but drowsy. He has a tracheostomy in place without supplemental oxygen. He is afebrile and has vital signs as follows: heart rate 65, blood pressure 95/60, RR 10–20, SpO₂96%. You notice a single 20-gauge peripheralIV in his hand and a weak smile on his face.