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An 88 yo M on aspirin and PLAVIX is BIBEMS for headache and vomiting the day after falling out of his chair and bumping his head on the floor. See the whole post HERE.
CT scan showed:
Interpret the Image
Acute right subdural hematoma with collections along the midline falx, along the right convexity and extending into the right tentorium. The hemorrage measures 1.5cm at maximum. Along the right tentorium the maximum measurement is 1.7cm AP. There is a small acute hemorrhage in the pre-pontine space. There is 6mm of midline shift.
Other than consulting other services, what is your management?
- Reverse anticoagulation – in this case, give platelets to reverse aspirin and Plavix.
- Keep the head of the bed elevated.
- Control blood pressure, SBP goal 140 (frequently with nicardipine).
- Place an A-line. This is one of those times it’s actually important emergently.
When neurosurgery says they don't want to operate, I should push for them to operate or transfer, right?
Bullock, M. R., et al. (2006). “Surgical management of acute subdural hematomas.” Neurosurgery 58(3 Suppl): S16-24;