Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Fall And Altered Mental Status


Consult Page

69F altered after a fall, CT brain bleed.

Initial Imaging

Figure 3.1, Axial head CT without contrast (A) demonstrates an 8 mm left sided, holohemispheric subdural hemorrhage with 7 mm midline shift. There are no skull fractures. CT c-spine without contrast (B) shows a C6 spinous process fracture not extending into the facets.

Walking Thoughts

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    What is the current GCS of the patient? Is she able to protect her airway?

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    What is the baseline function of the patient?

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    Does the patient take anticoagulation? If so, have reversal agents been given?

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    Are coagulation labs available or pending?

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    What are the patient’s medical comorbidities which may make surgery risky (e.g. pacemaker, chronic heart failure [CHF], severe chronic obstructive pulmonary disease [COPD])?

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    What was the mechanism of the fall? Are there concomitant cervical spine injuries?

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    Does this patient need to go to the operating room emergently?

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