Dr.Baker- Knobology

ALARA- As Low As Reasonably Achievable

High Frequency Probe- Good for superficial structures, High Resolution

Low Frequency Probe-Good for deeper structures, Low Resolution

Gain- Brightness

Depth

Zoom

Use these three to make your image clearer

Hyperechoic- Brighter (More echogenicity) than surrounding area

Hypoechoic- Darker (Less echogenicity) than surrounding area

Isoechoic-Same color (Same echogenicity) as surrounding area

Anechoic- Black. No color at all (No echogenicity)

Dr.Neal, PharmD- Sepsis  and Antibiotics

Sepsis- Life threatening organ dysfunction secondary to unregulated host response to infection

SIRS- hypo or hyperthermic, tachypnea, tachycardia, leukocytosis

Septic shock- Infection requiring vasopressors despite adequate fluid resuscitation

Good empiric choice should cover 80% of the bug you’re suspecting, based on local antibiogram

Give bacterial meningitis patients steroids to help reduce risk of side effects of infection (deafness, etc.)

Use source to guide your empiric antibiotic therapy

Dr.Howell, PharmD- Fluids and Vasopressors in Septic Shock

Maintain MAP > 65

30cc/kg bolus of fluids if hypotensive or lactate greater than 4.

Must document why if you give less

If fluids don’t maintain pressure, start vasopressors

Hypotension is due to decrease in systemic vascular resistance, use pressors that increase SVR

Norepinephrine is safe to start peripherally

Norepi is 1^st line for septic shock

Vasopressin is 2^nd line

Epi vs phenylephrine is 3^rd/ 4^th line, depending on scenario

Dr. Senn, PharmD- Rapid Sequence Intubation

Etomidate- GABA receptors, .3mg/kg, onset 30-60secs, duration 5-1min, minimal side effects of hemodynamics, may cause myoclonus. May cause some adrenal suppression but clinical relevance unclear

Propofol- GABA receptors, 1-1.5mg/kg, onset 10-30secs, duration 3-10min, may cause hypotension

Ketamine- NMDA receptors, 1-2mg/kg IV, onset 30-60sec, Duration 5-15min, Sympathomimetic and may cause hypersalivation

Succinylcholine- Depolarizing agent, 1-2mg/kg, onset 45-60secs (look for fasciculations), Duration 10-15min, may cause hypotension, causes hyperkalemia about .5-1 mEq rise transiently, may also cause malignant hyperthermia, use with care in peds due to underlying muscular dystrophy

Rocuronium- Nondepolarizing agent, .6-1.2mg/kg, onset 60-120s, Duration 30-45min

Vecuronium- Nondepolarizing agent,.08-.1mg/kg, onset 2-3min, Duration30-50min, may cause hypothermia

Have post-intubation sedation meds ready when asking for intubation drugs, do not want patient paralyzed but not sedated