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An ambulance brought a 28-year-old man to the emergency room. He was found on the street unconscious. In his wallet, he had a memo stating, “I have thrombocytopenia from aplastic anemia. If I pass out, please obtain a CT scan to rule out intracranial hemorrhage immediately. Thank you in advance.” Which test should you order next?
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head CT
A patient with severe thrombocytopenia who is found unconscious is at high risk of intracranial hemorrhage, and non-contrast head CT is the fastest and most sensitive first test for acute bleeding. It should be obtained before pursuing metabolic or toxicologic causes, and MRI or EEG would delay a time-critical diagnosis.