Author: Mohomed Ashraf Vahedna / Editor: Nick Tilbury / Reviewer: Ciaran Mackle / Codes: HC9, RP4, RP7, SLO4, SLO6, TP3 / Published: 13/04/2021 / Reviewed: 12/09/2025
Your emergency department (ED) receives a trauma pre-alert regarding an 80-year-old gentleman who has fallen at home during the night. His pre-hospital observations are deranged, and you put out a trauma-call. When the patient arrives, he tells you that he remembers tripping over the rug and landing on his right side. He is complaining of pain in the right hemithorax.
His past medical history includes atrial fibrillation, hypertension and Parkinson’s disease. His regular medications are candesartan, dabigatran and Sinemet.
His observations on arrival are as follows: BP 90/52, HR 110 bpm, SpO2 94% on 10L O2, RR 28/min, apyrexial
On examination he is alert but a little confused. He has bruises over his head, the right side of the chest wall and both knees.
A trauma CT is done, which reveals a massive right sided haemothorax with an arterial blush showing active extravasation from an intercostal vessel. No mediastinal or pericardial bleed is noted.
13 responses
Great topic. Quite relevant.
A simple and concise review of this serious presentation.
Execellent case. Very informative and “to the point”. Thank you!
Great topic
Good learning
very good case,I had painless hematuria case in elderly male,who was on dabigatran and mild hemophilia A. We gave praxbind and bleeding stopped. Very effective.
Good presentation
Great review
Interesting case scenario
Informative case
interesting case
excellant case
One of the interesting presentations in ED when the patient is on anticoagulation / DOAC. Reversal is important prior to any intervention. Nice module, Thanks!
Great one