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Thu Jul 9 14:01:50 BST 2009

Mike,
Whether or not the lady should have been a trauma patient is debatable; at the very least a trauma consult should be called.  I would indeed admit them both for observation (be it to medicine or trauma will be determined by your institution's policies), but given the fact that they both had normal CT scans, I would repeat the head CT only if they exhibit a change in their neurological exam.  For the female, I would ascertain the reason for her anticoagulation, and I would bet that she really doesn't need to be coumadinized (unless she had a valve!) given the risk of complications and/or death in her case from a stroke is far exceeded by the risk of complications and/or death from a fall.
Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Sise, Mike MD
Sent: Wednesday, July 08, 2009 9:30 AM
To: trauma-list at trauma.org
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