Need for Therapeutic Anticoagulation in the Setting of Penetrating Traumatic Brain Injury
59 MDW San Antonio United States
Pagination or Media Count:
Penetrating traumatic brain injury PTBI can be a disastrous mechanism of injury and has significant implications for ongoing management if the patient survives the primary injury. After ensuring hemodynamic stability and achieving hemostasis, the patient is likely to have both cognitive and functional deficits. A 29 year old male presented after sustaining a self-inflicted gunshot wound to the head. He was initially hemodynamically unstable, had minimal neurologic status, and had neurosurgical bleeding which was difficult to control due to superior sagittal sinus disruption. The patient remained bedridden, and although he received appropriate DVT prophylaxis, he developed a pulmonary embolus. The patient received therapeutic heparin, but as a result he developed intracranial hemorrhages necessitating multiple neurosurgical drain placements which were functionally short-lived. Due to these hemorrhagic episodes his heparin was intermittently held and resumed, culminating in multiple hemorrhages, herniation, and death.
- Medicine and Medical Research