The EPIC Project Prehospital Management of Traumatic Brain

The EPIC Project Prehospital Management of Traumatic Brain Injury In Arizona EPIC Refresher v 1. 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

EPIC Video Watch the video hosted on You. Tube: http: //youtu. be/UCRLGGJPa. Jc

Avoid Hypoxia Key Points • Keep SPO 2 > 90% • A single episode of hypoxia doubles mortality • Use any airway that maintains SPO 2 >90% and ETCO 2 at 35 -45 • If you choose to intubate – you take the responsibility to meticulously manage ventilation Treatment Apply O 2 before extrication Preoxygenate with high flow O 2 Even if SPO 2 is > 90% When you think C-Spine – think high flow O 2 • If you don’t meticulously manage ventilations – your ALS airway is actually WORSE than a BLS airway • •

Avoid Hypotension Key Points • Keep SBP > 90 mm. Hg • 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! Aggressively Treat & Prevent Initial 1000 m. L Bolus Repeat 500 m. L Bolus’ Repeat to keep SBP > 90 mm. Hg

Avoid Hyperventilation Key Points • 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 Tools for Success • • Meticulous Attention Rate Timers Pressure Controlled BVM ETCO 2 – 35 to 45 V-EMT-perfect ventilation Ventilation Spotter Ventilator

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

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