- A “brain bleed” also known as an intercranial hemorrhage or a subdural hematoma. Essentially what happens is that the brain suffers trauma as a result of sustaining a blow in a fall and because the blood does not clot properly, the bleeding of the small blood vessels in the brain continues unabated until there is a collection of loose blood in the brain cavity where it starts to put pressure on the brain and interfere with its normal operation; and
- Uncontrolled bleeding from fractures. Most people do not recognize it, but fractures bleed, and when someone on blood thinners suffers a fracture, there will be much more bleeding than you would see otherwise. This can cause a drop in blood volume which has its own set of medical consequences. Blood can pool putting pressure on nerves and complicating surgical repair of the fracture.
- The staff needs to be aggressive in implementing fall precaution interventions. The Coumadin related consequences of falls come into play after the fall has already occurred. Therefore, the staff must be alert for changes in condition which require additional fall precaution interventions as well making sure that all of the steps that are part of the fall prevention care plan are implemented day to day, shift to shift.
- Once a fall occurs, it needs to be taken seriously. Physician notification is required after all falls, but is a step that must be taken without fail for a resident on Coumadin. Often a trip to the emergency room for a CT scan to check for internal bleeding is appropriate. If there is not apparent major bleed, then frequent neuro checks are required to check for developing signs of a brain bleed. Surgery to address the brain bleed is only effective if the signs of the bleed are detected early enough.