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Unexpected severe intra-abdominal injuries resulting from a ground-level fall in an elderly patient with a large staghorn calculus
  1. Alexandre Lightfoot1 and
  2. James Chan1,2
  1. 1Mercy Health St Rita's Medical Center, Department of Emergency Medicine, Bon Secours Health System, Lima, Ohio, USA
  2. 2Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
  1. Correspondence to Dr James Chan; chan.332{at}


A 70-year-old woman on warfarin was transported to the emergency department after a ground-level fall, injuring her left backside. Criteria for geriatric trauma activation was not met. An episode of haematuria created suspicion for an intra-abdominal injury, prompting a point-of-care ultrasound (POCUS) Focused Assessment with Sonography for Trauma scan, which was positive. Subsequent pan-scanning discovered a multitude of injuries, including low-grade left renal and splenic lacerations, multiple left rib fractures and a haemothorax. Patient also had a supratherapeutic International Normalized Ratio (INR), which was reversed with 4-factor Prothrombin Complex Concentrate (4F-PCC). She was admitted to the intensive care unit, underwent urgent thoracostomy and had a complicated hospital course. Moreover, an incidental large staghorn calculus in the left kidney might have contributed shearing forces. In summary, under triage of this patient emphasised the importance of performing detailed primary and secondary surveys, including POCUS, for all geriatric ground-level fall patients on anticoagulants to allow for rapid diagnosis and treatment of potential serious injuries.

  • accidents
  • injuries
  • warfarin therapy
  • trauma
  • resuscitation
  • prehospital

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  • Contributors JC and AL conceived of the presented idea. JC and AL reviewed the case in detail, investigated current literature and assembled the case report. Both authors discussed the results and contributed to the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.