Tricky MKSAP quesiton
A 72-year-old man is evaluated in the emergency department for a severe headache, nausea, vomiting, and change in consciousness of 1 hour’s duration that developed after he fell earlier today. He has atrial fibrillation for which he takes warfarin and metoprolol.
On physical examination, temperature is normal, blood pressure is 160/90 mm Hg, pulse rate is 50/min, and respiration rate is 26/min. The patient is obtunded but responds to verbal commands and is able to follow simple instructions and swallow. No focal neurologic findings are present.
The INR is 12.
A CT scan of the head shows a subdural hematoma with a mass effect.
Which of the following is the most appropriate treatment?