Emeregency medicine literature of note. Anticoagulants and head injury. So what to do? We are told to image. To manage outside of a hospital setting without imaging is extremely challenging. I recall a recent patient from a rest home with head injury and dementia. I sent them to hospital. You could argue why? Well no advance directive 5% chance of ICH. What will the rest home do in the middle of the night? Perhaps a family discussion and advance directive would be useful to say we would not treat a ICH. But what about patient suffering?