head injury and aspirin

[William Bromberg]

Well, I have a little different take.

If the aspirin was given within 6-8 hours you might as well pour the
platelets on the floor  rather then give them to the patient — they
will work the same and there is no risk of transfusion reaction or
development of antibodies (the elimination half life of salicylic acid
is 6 hours so even by 8 hours you'd have about half a dose running
around inside killing platelets). 

If it's over 12-24 hours — no brainer, new platelets will work.

If the ER doc was just pointing out that Grandpa took 2 Goody's powders
for his headache 2 hours ago and that you'd just be wasting platelets he
had a point, otherwise not so much.

Bill

>>> "Ronald Gross" <Rgross at harthosp.org> 5/13/2008 1:05 PM >>>
I would give the platelets in this situation given the fact that the
neurosurgeon needs to worry about the head bleeds, the ortho MD needs to
fix the femur and I will still be worrying about an occult
intraabdominal and/or retroperitoneal injury, not to mention the
multiple rib fractures, hemopneumothorax and potential need for surgical
intervention beyond the obvious.

Now, at the risk of offending my emergency medicine colleagues, I would
add that the EM MD can "vocally argue against" the administration of the
platelets only if and when (1) that EM physician is the admitting
physician responsible for the patient's care once the patient leaves the
ED, and (2) that EM physician can give good hard Level I evidence to
support his or her vocal admonitions.

Just my 2 cents,
Ron

>>> "daniel simon" <danielsimonster at gmail.com> 5/13/2008 11:24 AM >>>
An elderly ( 82YO) pedestrian was hit by a car. His GCS is 11, his
injuries
include cerebral contusions, small SDH, multiple rib fractures and  a
femur
fracture. He is intubated and ventilated.He is on aspirin. The
neurosurgeon
wants to give him 6 units of platelets, The ED physician vocally
argues
against it.. What is your opinion?

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