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Sun Oct 9 22:01:17 BST 2005

Does she have a history of warfarin or other anticoagulants prior to crash?

Andrew Bowman
----- Original Message ----- 
From: "Maureen Canavan" <scho26 at sbcglobal.net>
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Sent: Sunday, October 09, 2005 3:35 PM
Subject: Re: head CT

>
> No LOC at time of admission, she was sent to the floor and she
communicated with staff thru the evening and early morning.  She was found
unresponsive about an hour after her last check..No LOC reported in the EMT
report or by pt or husband
>
> DocRickFry at aol.com wrote:
> In a message dated 10/9/2005 1:32:14 P.M. Eastern Daylight Time,
> scho26 at sbcglobal.net writes:
>
> Had a elderly lady PMH asthma, involved in a MVA rollover,dx. fracture
> pelvis..after twenty four hours she was found unresponsive she was
intubated
> and sent to CT with a diagnosis of large SDH with midline shift.
Unfortunately
> no CT of head was done in the ER. Should this be protocol and is it
protocol
> in other level one hospitals, when the MVA is a rollover???
>
>
>
>
> It is now pretty clear that mechanism should not dictate ANY specific
> evaluation--well established to be very unreliable, you should deal with
the
> patient as they present to you. And you do not give the crucial bit of
info needed
> to know if head CT should have been done on admission, tho I cannot
imagine
> how it could not have been indicated with what you describe--was there any
> history of loss of consciousness or GCS<14 on arrival? This is the
indication
> for head CT, nothing about mechanism.
> ERF
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