You are working a night shift in A&E. A 82 year old gentleman attends with his son. The son reports that his father had a fall earlier that day. The son was in the house, but did not witness the fall. Since then, his father has been unable to recall the events of earlier that day. The patient reports “feeling well”. He has noticed some bruising to his forearm, but is unsure how this has happened. He is normally independent and lives alone. He is currently on medication for hypertension, type 2 diabetes and had a valve replacement a number of years ago. He is very keen to go home as he feels perfectly well!
What are you concerns in this case? Differential diagnosis?
What would be your immediate management?
TeamHaem 
82 had a fall, on meds for valve replacement, life long anticoagulation? Whether he had an inteacerebral bleed? What is his INR if on warfarin
Immediate management: neurological assesment, request urgent CT scan and send a sample for clotting and INR. If clinically suspecting intracerebral bleed need to reverse his INR