Anti coagulated head injuries and delayed bleeds....
The Resus Room
Simon Laing
4.8 • 678 Ratings
🗓️ 15 September 2016
⏱️ 15 minutes
🔗️ Recording | iTunes | RSS
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Summary
In 2014 NICE updated their guidelines on Head Injury: assessment and early management. This included specific guidance for those patients on warfarin
Guidance regarding the ongoing observation of these patients is not contained within the guideline but as with much of Emergency Medicine variation between departments and regions vary in the threshold to admit patients with a normal CT head due to concerns of these patients developing a delayed bleed.
A recent systematic review and meta analysis on the topic has just been published and we thought it would be worth a look.
The paper gives an interesting take on the risk we are dealing with following a normal scan in presentation to the ED and whilst the papers contained may not be the strongest level of evidence the meta-analysis is probably the best we have to go on at present.
Enjoy and we'd love to hear any of your thoughts!
Transcript
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| 0:00.0 | And out of ten Rob, how many got it in? |
| 0:10.6 | I think you'd one get it in, amazingly. |
| 0:13.1 | It's been superb so far. |
| 0:14.4 | It's been nothing but an enjoyable experience, Simon. |
| 0:17.1 | Thank you. |
| 0:17.9 | But they also included in intubation. |
| 0:20.6 | Really? I didn't see that. |
| 0:21.9 | Don't do this. |
| 0:24.5 | Welcome to the Recess Room podcast. |
| 0:27.3 | Five, four, three, two, one, fire. |
| 0:35.4 | Hi, and welcome back to the Recess Room podcast. I'm Simon Simon Lang and I'm joined again by Rob Femnwick. |
| 0:42.0 | Good evening everyone. Right Rob, this podcast is on the topic of anti-coagulation and head injuries and it's a massive topic because it's probably something that comes up every day in the ED about what we're going to do with our patients when they're on anti-corregulation and what we do with them when they're being scanned. |
| 0:59.5 | Yep, certainly part of everyday emergency medicine practice, whether that be in the emergency department, |
| 1:04.8 | whether it be on the CDU unit, it's something that we come across every day. |
| 1:09.3 | So just to add a bit of context to this, so in 2014, |
| 1:12.9 | Nice changed their head injury guidelines to state that anybody who's on warfarin should be |
| 1:19.9 | getting a CT head scan within eight hours of injury. This is slightly different to the guidelines |
| 1:25.5 | that existed before. We certainly become more pro-scanning for our patients who are on warfarin. |
| 1:30.3 | Now the thinking behind that is obviously that if people are on anti-coagulants, |
| 1:34.3 | they're more likely to have an intracerebral hemorrhage. |
| 1:36.3 | But the problem that we seem to come across is what we do when the patients have had their scan, |
| 1:42.3 | seem neurologically normal, but in the back of our mind, |
... |
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