Elederly falls on Coumadin or Plavix

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speaking as a country doctor and not a neuro or trauma surgeon:
 
I'd prefer to admit both of these patients for overnight observation,  
including repeat imaging studies in the morning and at least two more sets of  
cardiac enzymes in the male patient.
 
With normal initial imaging, and minimal symptoms (including the lack of a  
large superficial hematoma in the female patient), I'd probably be 
comfortable  watching them in a facility with a decent telemetry unit IF there was 
no  indication that on coming weather might compromise rapid evacuation of 
either  patient to a higher level of care if needed. This is a consideration 
since most  of the facilities I have worked at in my career have been Level 
III or IV  facilities and a definite lack of neurosurgical support. My 
experience with  referring patients like these to major trauma centers has been 
that most similar  cases have been evaluated on arrival, often re imaged, and 
then released home to  their families.
 
ck
Charles S. Krin, DO
 
 
In a message dated 7/8/2009 07:33:05 Central Standard Time,  
Sise.Mike at scrippshealth.org writes:

82 year  old woman on Warfarin (Coumadin) 5.0 mg per day trips on a rug, 
falls striking  her forehead. She is brought to the Emergency Department by 
her daughter who  she lives with. She is amnestic for the event and has a 
superficial forehead  abrasion. Her physical examination is normal, her head CT 
scan is also normal,  and her INR is 3.0. Should she have been made a trauma 
patient? Do you admit  her for observation? Do you schedule a repeat head 
CT scan and if so, how many  hours later?

75 year old man on Clopidogrel (Plavix) 75 mg daily for  recent placement 
of a drug eluding coronary stent is in a moderate speed MVC  and complains of 
left shoulder and arm pain. He has an A-C separation but an  otherwise 
negative workup including head CT and torso CT and EKG. Should he be  admitted 
for observation? Should he have a repeat head CT scan and if so,  when?

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