Head Injury & Warfarin

Head Injury & Warfarin

71 yr old male is brought to Resus by paramedics with the history of difficulty in walking for a day and acute confusion. His wife says he has been fine in the recent past apart from a simple fall he had 2 weeks ago for which he received 2 stitches on forehead in the A&E.
— PMH Atrial Fibrillation (on warfarin)

Physiology

A – Clear

B – RR 14, Sats 98% (21%)

C – HR 80 (irreg) BP 170/95

D – GCS E3V4M5, PEARL Bilat

E – Temp: 36.9°C

Clinical Findings

  • Confused

  • Dressing to forehead


Why We Simulated

  • Fatalities secondary to intracranial haemorrhage occur in approximately 1% of anticoagulated patients annually.
  • Failure to recognise and act on patients with head injuries on anticoagulation can lead to significant morbidity as well.
  • The process of obtaining Prothrombin Complex Concentrate requires several steps and can be challenging if staff are unfamiliar with it.

Learning Points

  1. Vitamin K should be given as well as Prothrombin Complex Concentrate (as it will take effect as the PCC wears off).

  2. Guidelines are accessible via the trust intranet - see the slide show below.

     

Positive Feedback

  • Quickly identified potential diagnosis and need for CT Head.

  • When team member was unable to find the guidelines they asked for help.

  • Recognised Octaplex (PCC) is a blood product and requires consent

    • Also: recognised this patient lacked the capacity to consent.

Edit & Peer Review by Rebecca Prest
Hot And Bothered

Hot And Bothered

Lightning Learning: Head Injury

Lightning Learning: Head Injury