Here are some philosophical musings to keep you thinking over the weekend.

You are the trauma surgeon on duty one evening, and you receive a call from the emergency department. They have received a mildly demented elderly woman who fell at her nursing home 12 hours ago. The staff believes that her mental status is slightly “off” from what it usually is.

Your trauma program has a well-defined practice guideline for elderly TBI care (not on anticoagulants) that involves an initial CT scan, and then a repeat scan after another 12 hours if anything but a simple subarachnoid hemorrhage (SAH) is present. For just SAH, only serial neuro checks are performed for 12 hours and a TBI screen is performed prior to discharge.

Here are my questions for you:

1. What scan(s) do you need to perform given that 12 hours have already passed since her injury?
2. Does the patient need to be admitted? For how long?
3. What other important information do you need to know?
4. Should the patient have been sent to the ED at all?

I am very interested in your input on these questions. I’ll discuss them in detail in my next post. Please leave comments below, tweet, or email your responses and I’ll see how much we think alike. Or not!