Car accidents & coumadin

[LL_beanie]

Strangely (and luckily), for the 23 years I've been on Coumadin, I never thought about this...does anyone have experiences or have been told what to do if you are in a car accident?

Last week, I was driving my mom's van on the freeway, and the rear tire blew out. The state trooper who came later said it was probably the heat of the asphalt and tires that did it since the tires were pretty new. We skidded clear off the highway about 50 yards down....into sharp incline into a field, but we didn't flip and we didn't hit a set of trees. No airbags went off, although the back bumper was ripped off and the front axels were pushed deep into the earth.

It's hard to say this, but the two open-heart surgeries I've had, plus visits to see if I needed a heart transplant didn't even approach the fear of that blowout. I thought that was the end of my life in a very real way (side note: before the surgeries, I had made peace if anything went wrong, but the car accident, all I could think about was NO, not today...)

Anyway, no one was hurt, the van was retrieved by a wrecker, who dropped us off at the local hospital. I was concerned bc my INR is usually pretty stable but for the past several weeks, it's been shooting up more than normal, and two days before it was 4.2, so I had to hold a dose. The emergency room docs ran a PT - my INR was 2.7 on the day of the wreck and no symptoms of internal bleeding.

But it made me think, does anyone have a strategy or advice on what to do if you are in a car accident or something similar? I've only been a couple of low-speed fender benders, like being bumped from behind, but if the van had flipped or if you get cut with glass, what to do?

I do have a medical tag alert I wear all the time, but other tips would help. Sorry so long, it's just something that's been on my mind.

 

[Freddie]

For myself, I have placed a medical alert information piece of paper (laminated) on the drivers side sun visor. Basically it lists the same information that's on my medical alert tag along with my doctors name and phone numbers.

I've placed it on the visor so you can see it when the visor is in the 'up' position - and it's clearly seen through the windshield when the visor is 'down'.

 

[catwoman]

I wear a Medic-Alert watch-style bracelet and have a Medic-Alert decal on a car window (rear window on driver's side of my Honda CRV). I do need to replace it -- it's 8 years old and has faded -- and get an additional one for my husband's car in case I'm in that car.

Other than that, I don't worry too much.

My nephew-in-law is a captain for a fire-rescue department in the Dallas, Texas, area. I will e-mail my niece (a former firefighter herself and now an RN at a small emergency practice) and ask for both of their input on this. I'm sure my NIL has worked accident scenes and my niece may have also.

FWIW: If I am ever involved in an auto accident and the airbag goes off, I will demand to have an echo and even a TEE and have those repeated for a while. Many of you are familiar with my husband's story: His car was hit head-on during bad icy weather, airbag went off, fracturing his sternum. Only X-rays done @ hospital the next day. Sternum healed. However, the sudden deceleration trauma had ruptured one or more chordae to the leaflets of his mitral valve. He did not have symptoms until several months after his sternum had healed. He had MV repair 17 months after the car accident.
I have no mitral chordae that can rupture. However, I still have my native tricuspid, which does have chordae. And deceleration trauma can tear the aorta, do other damage to the heart.

You can't predict the other driver's actions. Best to practice defensive driving!

 

[Protimenow]

I have a faded medic-alert style medal around my neck. I will probably have the words 'I take anticoagulants' engraved into the back case on my cell phone. The idea of something on the visor sounds interesting.

Two years ago, when I had a concussion and the company where I was had medical insurance, a brain CT was a good idea.

However, aside from the thing around my neck, I really don't have much to indicate that I've got a prosthetic valve (of course, there's the ticking -- presumably EMTs or physicians would be able to hear it and figure out that I've got a man made valve and am on warfarin - if the bruising hasn't already tipped them off)

 

[Marty]

Interventional/Surgery
Data from 1.23 million patients confirms warfarin increases mortality in trauma patients
October 20, 2009 | Reed Miller, American College of Surgeons

There's no doubt being on warfarin increases your risk in a car accident particularly if you get hit in the head. Just how you get treated is a bit of a mystery and up to the individual surgeons. Most centers do not have a protocol for correcting coagulopathy. Possible treatments include Vitamin K,factor V11,fresh frozen plasma, etc.

 

[Protimenow]

A few things that could be helpful for anyone in an accident have been proposed and tried before. Technology still hasn't accepted everything. I saw a device a few years ago - it looked like a Thumb Drive - and had an app that contained medical history and other information. It was poorly promoted, it wasn't as obvious that it had medical information as it should be. Having USB readers in the field may not be as ubiquitous as you'd like. Having your medical records and history where emergency personnel can read (and recognize) them would make a lot of sense. Letting people know your history or other medications could save your life.

There are other devices being developed that include history and updates. RFID (radio frequency ID) devices can summarize your most important information - and should be readable in ambulances and emergency rooms.
There are many other technologies in the works that will make it easy for people with the right reader (and possily an unlock code) could use to get valuable medical information. A lot of what may be involved in providing imporant information even if you're not conscious can help you to get appropriate information to the medical personnel who will eventually try to help you.

The world is changing and, soon, it may be much more easy to share information (even encrypted for privacy) with authorized emergency personnel.

 

[catwoman]

I have not been able to reach my niece for input from her firefighter/EMT husband, but I did ask them the same question several years ago.
At that time, Jake said they check any medical-type jewelry on the patient. If there's a phone # on it, they call for info. At that time, my sister questioned whether a bracelet or necklace would remain on the accident victim. I told her of course -- unless your hand/arm is cut off or you're decapitated. I was being sarcastic, of course, because those are very far-fetched scenarios.
Jake also said the OHS incision would be a dead (no pun intended :biggrin2 giveaway and the ID bracelet/necklace would be the icing on the cake. (40 years in the news business has jaded me!)

Your wallet or purse may be strewn in the debris of an accident. That's why I opted for the medical alert bracelet.
It's working -- I haven't had a car accident since my MVR.

 

[Protimenow]

I'm not sure that just having an OHS scar is a tipoff that you're taking warfarin -- it just shows that your chest was opened. If you had a bypass operation, you'd probably have a similar scar (and not be taking warfarin). Other chest surgeries would also probably look the same - and not require warfarin.

I keep my St. Jude's card in my wallet, under my driver's license. I wear a medal on a chain around my neck. I'll probably get a case for my phone with an engraved back that says 'I take coumadin' (EMTs may be more familiar with the patent name than they are the generic name). It shouldn't hurt to try to let the emergency medical people know you're taking an anticoagulant and, short of getting a tattoo that says you're taking coumadin, these few things should be of some value.