## Is the blind subclavian central line a thing of the past? Do you have any tips for the use of ultrasound when doing subclavian lines in regarding to getting a good view? - Ultrasound Guided Subclavians [Ultrasound Gel Episode](https://www.ultrasoundgel.org/posts/yhGXqODKV4EIXn548_5BHw) https://pubmed.ncbi.nlm.nih.gov/35562246/ ### How to Do It the ultrasound machine was set up on the opposite side of the subclavian vein to be catheterized. With the linear transducer at the inferior aspect of the lateral clavicle and indicator cephalad, the operator located the axillary vein and artery in short axis. Then they moved medial to identify the subclavian vein and prepare for cannulation. Short axis, out of plane approach based on images Pointers (from us): -    Visualize lung and avoid it -    Use first rib as backboard in long axis -    [“Subclavian shrug”](https://www.youtube.com/watch?v=FpJFkPOfNHM) to expose vein -    Vein can appear pulsatile. Find the artery, know anatomical relationship. Learn how to perform [ultrasound-guided vascular access from 5 Minute Sono!](https://www.coreultrasound.com/central-venous-access/) ## In an undifferentiated post-cardiac arrest patient, is there a MAP goal that we should ideally be targeting in terms of outcomes? Is there any difference between 65 vs trying to get it up to 70-90 in your view? ## In patients with septic shock that we are resuscitating in the ER, when we are at the point of adding vasopressin to norepi, do you consider adding steroids concomitantly as well? ## Is the ARDSnet titration a relic at this point? What are you using in your sick ARDS patient, are you using driving pressure, ect? Based on the Amato study, a driving pressure < 15 seems associated with lower mortality, even in patients with elevated plateau pressures. Conversely, patients with Plats < 30, but driving pressures >=15 still seem to be at risk ## In regard to using stress index, do you have a quick and easy way of visually estimating the stress index and do you use it and if so, how do you use it? https://rc.rcjournal.com/content/63/9/1094  [Gattinoni on selecting the right PEEP](https://emcrit.org/wp-content/uploads/2016/07/Seleccionando-el-PEEP-adecuado-COC-2015.pdf) ## In patients with status asthmatics in the ED, when do you make the decision to use ketamine as well as things like epinephrine? ## Our institution does not have TEG at this time. At what point in your MTP are you empirically giving calcium, and how much are you giving?