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

2. 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

3. EPIC Video Watch the video hosted on YouTube:

4. 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

5. 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

6. 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

7. 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

8. For your dedication to saving lives from TBI in Arizona
Thank you
For your dedication to saving lives from TBI in Arizona