The EPIC Project Prehospital Management of Traumatic Brain Injury In Arizona EPIC Refresher v1.1 8/23/2013

Who Gets EPIC Treatment? Trauma patients from any cause AND any of the following: Any loss of consciousness GCS of 14 or less Multisystem trauma requiring intubation Any post-traumatic seizures 3rd bullet explanation: Multisystem trauma requiring intubation whether the need for intubation was from TBI or other potential injuries

EPIC Video Watch the video hosted on YouTube: http://youtu.be/UCRLGGJPaJc

Avoid Hypoxia Key Points Treatment Keep SPO2 > 90% A single episode of hypoxia doubles mortality Use any airway that maintains SPO2 >90% and ETCO2 at 35-45 If you choose to intubate – you take the responsibility to meticulously manage ventilation Apply O2 before extrication Preoxygenate with high flow O2 Even if SPO2 is > 90% When you think C-Spine – think high flow O2 If you don’t meticulously manage ventilations – your ALS airway is actually WORSE than a BLS airway

Aggressively Treat & Prevent Avoid Hypotension Key Points Aggressively Treat & Prevent Keep SBP > 90mmHg A single episode of hypotension at least doubles mortality Use extreme caution when using pain meds/sedatives They can rapidly drop blood pressure Once we give them – we can’t take them back! Initial 1000mL Bolus Repeat 500mL Bolus’ Repeat to keep SBP > 90mmHg

Avoid Hyperventilation Key Points Tools for Success If we aren’t paying constant attention to ventilation, we will harm our patients A single instance of hyperventilation doubles mortality Never hyperventilate! – no matter how bad you think the patient’s injury is Meticulous Attention Rate Timers Pressure Controlled BVM ETCO2 – 35 to 45 V-EMT-perfect ventilation Ventilation Spotter Ventilator

Avoid the H-Bombs for Kids Too Hypoxia Early, high flow O2 administration Hypotension Prevent and aggressively treat: 70 + (2 x age) Systolic BP or use Broselow Don’t let B/P go below this number 20cc/kg bolus to maintain SBP Hyperventilation Meticulously monitor your ventilation-rate AND depth Infants (0-24 months): 25bpm Children (2 – 14 years): 20bpm Adolescents (15+): 10bpm Once on Capnography - Maintain ETCO2 at 40 (35 – 45) Infant <2 BP ≥70 25 BPM Child BP ≥80 20 BPM (to Age 14) Child 10+ BP ≥90 5 10

For your dedication to saving lives from TBI in Arizona Thank you For your dedication to saving lives from TBI in Arizona www.epic.arizona.edu