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Anticoagulants and Head Injuries. Robyn Mazzolini, RN, TNS EMS Coordinator Lutheran General Hospital. Objectives. State the trend observed by LGH Trauma Department regarding anticoagulants and head injuries. List some common anticoagulants and indications for use.
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Anticoagulants and Head Injuries Robyn Mazzolini, RN, TNS EMS Coordinator Lutheran General Hospital
Objectives • State the trend observed by LGH Trauma Department regarding anticoagulants and head injuries. • List some common anticoagulants and indications for use. • Discuss how ECF staff is notified that a resident takes an anticoagulant. • Review normal physiologic changes to the aging brain and mechanisms of injury. • Discuss medical management of the resident on an anticoagulant with a head injury.
We Have Noted… Lutheran General Trauma Department has identified over the last 6 months an increase in mortality due to falls with head injuries for residents on anticoagulants. Did you know? According to the CDC, a person > 65 years of age dies every 35 minutes due to complications from a fall.
Common Anticoagulantsand Indications • Coumadin (warfarin) indicated for venous thrombosis, pulmonary embolism, atrial fibrillation, cardiac valve replacement, reduce risk of recurrent myocardial infarction and stroke. • Aspirin indicated for treatment of pain/inflammation from arthritis, soft tissue injuries, pain, fever, and to decrease risk of recurrent stroke, transient ischemic attack (TIA) and myocardial infarction. • Lovenox indicated for deep vein thrombosis, unstable angina, and myocardial infarction. • Plavix indicated to reduce thrombotic events such as myocardial infarction, stroke, peripheral vascular disease and acute coronary syndrome.
How Does Your Staff Know? How does your ECF staff know that a particular resident takes an anticoagulant? Time to brainstorm!
Falls in Extended Care FacilitiesReference: Centers for Disease Control and Prevention • Each year, an average ECF with 100 beds reports 100-200 falls. • About 1800 older adults living in ECFs die each year from fall-related injuries. This accounts for 20% of the deaths in this age group. • Traumatic Brain Injury, or TBI, is caused by a jolt, bump or blow to the head.
Physiologic Changes • As we age, our brains lose mass which allows for increased movement within the skull with any kind of trauma. • There is an increased subdural space – more room for bleeding.
Mechanism of Injury • Even with minor head trauma, the resident on an anticoagulant is at great risk for a significant head injury. • Especially at risk: unwitnessed falls.
Possible Injuries Intracerebral bleed Subdural bleed Epidural bleed
What Should You Do? One of your residents falls – what should you do? • Your staff should call 911. • Do not move the resident! • Maintain cervical spine in alignment and keep airway open.
What Do We Do At the Hospital? Stop the bleeding! • With a patient on coumadin, within one hour of positive CT scan we administer fresh frozen plasma and vitamin K. • With a patient on aspirin, within one hour of positive CT scan we administer platelets. • We have an extensive 2 page guideline for reversal of anticoagulants.
Case Study One of our recent deaths: Mrs. S, an ECF resident, fell one evening while walking with her cane and bumped her head. She denied any injury, felt fine, and the NCT helped her up and into bed. Unfortunately, Mrs. S was unconscious and unresponsive by the next morning. On CT she had a large subdural bleed. Mrs. S was on Coumadin. We believe delay in care contributed to her poor outcome.
In Summation • We suggest any resident that is on a blood thinner, that suffers a fall, needs to be immediately transported to a hospital for an evaluation. • Do not wait for a change in mental status, often it is then too late to intervene to decrease morbidity and mortality.
