Trauma with anticoagulation — DipIMC MCQ

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ModerateTraumaTrauma with anticoagulationDipIMC

An 82-year-old on apixaban falls down six stairs. She is alert but has a scalp wound, vomiting and a new headache, with normal blood pressure. What is the most appropriate management?

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Correct answer: E — Pre-alert and convey for urgent CT at an appropriate trauma receiving unit

Explanation lettering: E = shown as A · A = shown as B · B = shown as C · C = shown as E

C is correct: Older anticoagulated patients can deteriorate despite initially reassuring observations and need urgent imaging pathways. A is less suitable because the vignette contains high-risk features that require escalation; B is less suitable because it moves the patient before the decisive threat or destination issue is addressed; D is less suitable because it does not address the discriminator in the vignette; E is less suitable because it does not address the discriminator in the vignette. The most tempting alternative is therefore suboptimal because it either delays the time-critical pre-hospital intervention or sends the patient to the wrong level of care. The key DipIMC principle is focused cABCDE decision-making with early pre-alert, triage or retrieval escalation when the scene physiology demands it.

Reference: JRCALC Guidelines; NICE Major Trauma NG39; ATACC