Handtevy Minute: Severe Traumatic Brain Injury (TBI)

60,000 people die from TBI every year in the United States, and as EMS professionals we can have a big impact in outcomes.

How can EMS impact care?

Dr. Antevy makes a strong case for all EMS agencies to adhere to the recommendations made by the 2019 EPIC-TBI study and the 2022 follow-up study that was published in July.

While the recommendations may appear simple, they are difficult to adhere to unless you are actively focusing on them, even prior to arrival on scene.

Here is a summary of the EPIC-TBI recommendations (2019 & 2022)
For Severe TBI:
• Avoid Hypoxia - place a NRB on all patients immediately
• Avoid Hypotension - place 2 large bore IVs and aim for a SBP of 130 mmHg (not 90!)
• Permissive hypotension is not an option in TBI.
• Avoid Hyperventilation - Keep the ETCO2 b/w 35-45

We recommend that you review every TBI case and look for the above parameters.
One episode of hypoxia or hypotension significantly increases the odds of a bad outcome.

The Key Takeaways:
1. Avoid the 3 H-Bombs in Severe TBI
2. Reconsider the BP threshold of 90 mmHg in favor of higher SBPs (130’s)
3. CQI every TBI Case looking for these items.