EM Forum Case #104
"The Little Deadly Bump"
by Charlene Babcock Irvin, MD, FACEP
An 85 y/o woman presents from home after bumping her head. She stated she was opening one of the upper kitchen cabinets, and she lost her balance so she pulled on the cabinet and it flew open and hit her at the right side of the head. There was no loss of consciousness, no bleeding, and she only came to the ED because her son came over later and insisted she get checked out. She never fell, and did not pass out, get dizzy, have any chest pain, shortness of breath, near syncope, vertigo, or any other neurologic complaints. She simply lost her balance as she reached up to open the upper cabinet.
PMH: CHF, HTN, and Atrial Fibrillation. No hospitalizations in the past 3 years for these conditions.
SH: Lives alone, takes care of her own house, pays her own bills, and is generally quite healthy and neurologically in tact. No smoking or drinking.
Meds: Lasix, Potassium, Metoprolol and Warfarin.
PE: Very pleasant, smiling, frail, elderly woman in no acute distress. HR = 77, BP= 155/90, RR=20, Afebrile, Sat=97% on Room Air
HEENT: PERRL, EOM intact, there is a small (1 cm) contusion noted on the right temporal area of the scalp; otherwise exam normal.
Heart: Irregular rate, no murmurs.
Lungs: Clear bilaterally, no rales.
Abd: Soft, nontender, scaphoid, no masses. Rectal: Guaiac Negative.
Ext: Normal, unremarkable.
Neurologic: Normal motor, sensory, reflexes, mental status, cranial nerves, and cerebellar exam.
Questions:
1. Do you need to do any tests? Does she need a CT of the head?
2. What would you do if she had an elevated INR?
3. What are the different ways to give Vitamin K?
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