Elederly falls on Coumadin or Plavix

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Hi Mike

In South Africa we would not re-image in this patient group unless there
was a change in clinical picture. They would have been "trauma patients"
as all injuries come through the trauma services (in most hospitals there
are seperate trauma and non-trauma emergency sections in our EDs) - they
would not necessarily have become a trauma surgical unit patient however;
she may well be kept for 24 - 48 hours in the ED short stay ward and will
certainly be discharged with a "Head injury form" with instructions to the
family to look for signs of neuriological change and then to return to the
ED with the patient. This is especially the case with the first patient as
there is a chance of a chronic subdural of around 5 - 10%, although only
about 5% ogf those would need drainage.

Regards
Tim
Dr T C Hardcastle
M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma Surgeon /
Honorary Lecturer University of KwaZulu-Natal Dept Surgery
Deputy Director - IALCH Trauma Service
Durban - South Africa

> 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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