The TBI ‘H bombs’

Dr. Al Lulla breaks down an area where we can improve outcomes

In this episode of the MCHD Paramedic Podcast, join our host, Casey Patrick, MD, FAEMS, assistant medical director for the Montgomery County Hospital District EMS, for a discussion of some of the recent literature surrounding EMS care of traumatic brain injury with Dr. Al Lulla.

This is the perfect confluence of advancing evidence, relatively straightforward interventions, and a patient population where we can definitely improve prehospital outcomes. See where the literature, education and protocol implementation can meet to improve TBI outcomes in your EMS service.

Learn more about the H-bombs of TBI:

  • Hypoxia
  • Hyperventilation
  • Hypotension

Additional resources on managing TBI


1. Spaite DW, Hu C, Bobrow BJ, et al. Optimal Out-of-Hospital Blood Pressure in Major Traumatic Brain Injury: A Challenge to the Current Understanding of Hypotension. Ann Emerg Med. 2022 Jul;80(1):46-59.

2. Spaite DW, Bobrow BJ, Keim SM, et al. Association of Statewide Implementation of the Prehospital Traumatic Brain Injury Treatment Guidelines With Patient Survival Following Traumatic Brain Injury: The Excellence in Prehospital Injury Care (EPIC) Study. JAMA Surg. 2019 Jul 1;154(7):e191152.

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