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Wed Jul 8 15:04:13 BST 2009

Yes would admit for observation and repeat head ct either with any neuro change or the next day.? If any abnormality is seen on first scan our NS repeat in 4-6 hours and activity reverse for coumadin and given plts for plavix.? Although plts do not "reverse" plavix, they do give the pt a few "working plts"

Rebecca Wolfer, MD, FACS, FCCP
Associate Professor, Marshall University School of Medicine
Dept of Surgery
Director Thoracic Surgery
Director, Surgical Critical Care Cabell Huntington Hospital
Director, Trauma Cabell Huntington Hospital

-----Original Message-----
From: Sise, Mike MD <Sise.Mike at scrippshealth.org>
To: trauma-list at trauma.org
Sent: Wed, Jul 8, 2009 9:30 am
Subject: Elederly falls on Coumadin or Plavix

Colleagues,

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?

Mike Sise
San Diego

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Elederly falls on Coumadin or Plavix