Trauma & EPIC TBI

Question 1

Shock Index >1

Answer 1

HR > SBP

Question 2

Initial Considerations..

Answer 2

Dead on Scene AG
OR
Traumatic Cardiac Arrest AG

Question 3

Types of Trauma

Answer 3

• Blunt Trauma
• Penetrating/Isolated Extremity Trauma
• TBI (Penetrating Head Trauma/GCS <15/Loss of Consciousness)

All w/ Risk of Hemorrhage

Question 4

Initial Actions

Answer 4

• Determine Type of Trauma
• Hemorrhage control (Tourniquet, Quickclot, Occlusive Dressing, Pelvic Binder)
• Airway Maintenance
• Breathing and Ventilation (Chest Decompression, Cricothyrotomy)
• 2 Large Bore IV’s/IO Access
• Cardiac Monitor
• Splint Obvious Fractures

Minimize scene times

Question 5

If Blunt Trauma..

Answer 5

• Apply C-Collar

> 14 years: Administer TXA 2 grams Slow IV/IO Push (over 2 min)

<14 years: Administer TXA 30 mg/kg
(2g MAX) slow IV/IO push (over 2 min)

• Administer NS/LR fluid bolus to keep SBP >110 mmHg

Question 6

If Penetrating/Isolated Extremity Trauma..

Answer 6

> 14 years: Administer TXA 2 grams Slow IV/IO Push (over 2 min)

<14 years: Administer TXA 30 mg/kg
(2g MAX) slow IV/IO push (over 2 min)

• Administer NS/LR fluid bolus to keep SBP >70 mmHg

Question 7

If TBI (Penetrating Head Trauma/GCS <15/Loss of Consciousness)..

Answer 7

• Supplemental O2 to Target Sat of 100%
• IV access with 18g IV (document exceptions, e.g. pediatric patient)
• Monitor HR, BP & O2 q 3-5 min & Initiate TX before the patient becomes hypoxic or hypotensive

Question 8

Prevent Hypoxia & Hyperventilation by..

Answer 8

• EtCO2 Target of 40 (35-45) for ventilated Pt’s
• Provide PPV if needed @ appropriate rate
• Consider I-Gel/ETI if Pt remains hypoxic (>8 yrs)
• Consider Tension Pneumo if O2 remains <90%

Question 9

Prevent Hypotension

Answer 9

• Not Hyperventilating
• 20 mL/kg NS/LR fluid bolus to keep SBP >110 mmHg [70+(agex2) for peds]
  Consider Shock AG/Call Medical Direction

Question 10

If SBP fails to improve..

Answer 10

• Repeat Fluid Bolus

Consider:
- Hyperventilation
- Tension Pneumo
- Push Dose Epi/Medical Direction

Question 11

Ventilation Rate for 0-24 mnths

Answer 11

25 bpm (1 breath q 2.5 sec)

Question 12

Ventilation Rate for 2-14 yrs

Answer 12

20 bpm (1 breath q 3 sec)

Question 13

Ventilation Rate for >14 yrs

Answer 13

10 bpm (1 breath q 6 sec)