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Head injury on anticoagulation — RCPSC EM MCQ

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ModerateTraumaHead injury on anticoagulationRCPSC EM

An 80-year-old man on apixaban fell down 6 stairs and struck his head. He is confused, vomited twice, and has a GCS of 13. Blood pressure is 168/86 mmHg and cervical spine tenderness is present. What is the most appropriate investigation?

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Correct answer: E — Urgent CT head and cervical spine

Anticoagulation, vomiting, altered mental status, and cervical tenderness after significant fall mandate urgent CT imaging of the head and cervical spine. Plain skull films are not adequate.

Reference: Canadian CT Head Rule; Canadian C-Spine Rule