A 73 year old man is brought to the ED by his neighbor after a witnessed trip &  fall over a hose in his back yard. It was a ground level fall and he hit the right side of his head against a knee-high brick wall in the garden. There was no loss of consciousness and he felt fine prior to tripping. He has a mild headache, but no other injuries. He talkes HCTZ, omeprazole and warfarin. His exam is normal except for a small contusion over his right ear.

His labs are normal except for an INR of 2.4. His head CT is normal. He feels fine and wants to go home. Where’s the mystery you ask? The mystery is to answer these question: 1.) What is the “standard of care” for such a presentation. 2.) What is optimal care for such a presentation, i.e. under what circumstances should there be consideration for FFP? for Vitamin K? for admission?

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