Not sure if GCS 15 and / or has capacity to understand but has anyone
thought of explaining the risk/benefit to the patient +/- family (not sure
of age either). As there is no definitive answer an explanation of the
dilemma may be appropriate. After all, it is the patient who is ultimately
going to undergo the risk.
Simon
Simon Carley
SpR in Emergency Medicine
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Evidence based emergency medicine
http://www.bestbets.org
----- Original Message -----
From: "Black, John" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, October 14, 2002 10:42 AM
Subject: Re: Anticagulation and Head injuries
> John,
>
> Prosthetic aortic valve is not as vulnerable to the effects of short term
> reversal of anticoagulation as mitral prosthesis (relaively high
flow/valve
> surface area).
>
> Saying that, I would balence the risks versus benefits - clearly any hint
of
> on going bleeding/deterioration in level of conscious or in any patient
> likley to require neurosurgery will require prompt reversal with FFP/low
> dose vitamin K. Otherwise, assuming your patient was well and there was no
> evidence of any subdural/extradural collection, I would admit & observe
him
> closely and await events.
>
> John Black
>
> -----Original Message-----
> From: John Ryan [mailto:[log in to unmask]]
> Sent: 12 October 2002 12:16
> To: [log in to unmask]
> Subject: Anticagulation and Head injuries
>
>
> I am aware the list has discussed this topic recently but I would like to
> add a new slant.
>
> Views on how to manage a young man with a head injury and headache
following
> a fall from his bicycle.... CT shows temporal contusion. This chap is on
> warfairn follwing his aortic valve replacement on a background of Marfan's
> Syndrome.
>
> The question is to reverse anticoagulation (INR 3.5) or not ?
>
> Dr John Ryan
>
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