head injury and aspirin

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  I would give the platelets in this situation given the fact that the neurosurgeon needs to worry about the head bleeds, the ortho MD needs to fix the femur and I will still be worrying about an occult intraabdominal and/or retroperitoneal injury, not to mention the multiple rib fractures, hemopneumothorax and potential need for surgical intervention beyond the obvious.

Now, at the risk of offending my emergency medicine colleagues, I would add that the EM MD can "vocally argue against" the administration of the platelets only if and when (1) that EM physician is the admitting physician responsible for the patient's care once the patient leaves the ED, and (2) that EM physician can give good hard Level I evidence to support his or her vocal admonitions.

Just my 2 cents,
Ron

>>> "daniel simon" <danielsimonster at gmail.com> 5/13/2008 11:24 AM >>>
An elderly ( 82YO) pedestrian was hit by a car. His GCS is 11, his injuries
include cerebral contusions, small SDH, multiple rib fractures and  a femur
fracture. He is intubated and ventilated.He is on aspirin. The neurosurgeon
wants to give him 6 units of platelets, The ED physician vocally argues
against it.. What is your opinion?

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