#SimBlog: Head Injury & Warfarin

““A 71-year-old male is brought into the ER by paramedics with the history of difficulty in walking for a day and acute confusion.””

— PMH Atrial Fibrillation (on warfarin)

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.

Observations

A – Clear

B – RR 14, Sats 98% (21%)

C – HR 80 (irregular), 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 slides below.

STEP 1: Insite Main Page

Step 2: Click On Emergency Department

Alternatively Search For What You Need

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