GEMECHIS
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Is a set of clinical interventions for the urgent
treatment of cardiac arrest and other lifethreatening medical emergencies, as well as
the knowledge and skill to deploy those skills.
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Adenosine
Amiodarone
Atropine
Dopamine
Epinephrine
Lidocaine
Magnesium sulfate
Procainamide
Sotalol
1 False regarding shock energy for defibrillation
A biphasic initial dose 125-200J,if unkown use
the maximaum dose
B monophasic,360J
C second or subsequent doses should be equal
or higher
D defib is indicated for PEA
2 Which one is a wrong statement?
A shock refractory VF/pulselessVT refers to when
the rhythm persists/recurs after 1 or more shocks
B an anti-arrythmic alone is unlikely to
pharmacologically convert VF/pulseless VT to an
organizing perfusing rhythm
C Amiodarone or lidocaine may be considered for
VF/pulseless VT that is unresponsive to
defibrillation
D The routine use of magnesium for cardiac arrest
is recommended in adult patients
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How about in covid19?
1.
OXYGENATION AND VENTILATION
Hypoxia during the early phase of reperfusion after
ROSC harms post ischemic neurons and increases
brain lipid peroxidation
 The suggested ventilator parameters during the
post-ROSC phase are as follows: PaCO2 between 35
and 45 mm Hg (5 to 6 kPa); SaO2 between 94% and
98%; tidal volume between 6 and 8 mL/kg ideal
body weight; PETCO2 between 35 and 40 mm Hg;
and 10 to 12 ventilations per minute.
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HEMODYNAMIC MANAGEMENT
Obtain 12-lead ECG after ROSC and repeat at
8 hours or as needed
The target for blood pressure is a mean
arterial pressure of 65 to 100 mm Hg.
 Brain cooling decreases cerebral oxygen
demand, reduces cellular effects of
reperfusion, and decreases the production of
reactive oxide radicals.
 Targeted temperature management (cooling
to 32 to 36°C goal is controversial) during the
first 24 hours after ROSC improves survival
and neurologic recovery
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GLYCEMIC CONTROL
Maintain blood sugar levels between 100 and
180 milligrams/dL (6 and 10 mmol/L).
NEUROLOGIC ASSESSMENT
Features of brain injury after ROSC include
coma, seizures, myoclonus, and various
degrees of neurocognitive dysfunction
ranging from memory deficits to a persistent
vegetative state and finally brain death
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A 72 year old male patient Known IHD after
CABG is in E-ICU with palpitations. Initial
spo2 is 94% on room air &patient put on
monitor. Go on managing the patient.
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What went well?
What do you improve?
Participant
Audience
Narrow Complex
 Regular
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Sinus Tachycardia
SVT
A flutter with 2:1 block
Junctional tachycardia
Irregular
SVT
Atrial fibrillation
 Atrial Fibrillation
 Atrial Flutter w variable
block
 Multifocal Atrial
Tachycardia
Atrial flutter with variable block
Wide Complex
 Regular
 Ventricular tachycardia
Ventricular Tachycardia
 SVT with aberrancy
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Irregular
 Ventricular fibrillation
Torsades de Pointe
 Torsades de Pointe
 Pre-excited Atrial fib.
SVT with aberrancy
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A 52 year old lady known DM,HTN admitted
to ED with severe chest discomfort and
dizziness.
Spo2 84% and BP=90/60
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What went well?
What do you need to improve?
Participant?
Audience?
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Six person
Clear roles and responsibilities
Closed loop communication
Know your limitations
Mutual respect
Knowledge sharing
 The end!