0071643192.pdf

SYMPTOMS/EXAM

■ Vertigo

■ Hearing difficulties

■ CSF otorrhea or rhinorrhea

■ Mastoid ecchymosis (Battle’s sign)

■ Periorbital ecchymosis (raccoon eyes)

■ Hemotympanum

■ Seventh nerve palsy

TREATMENT/COMPLICATIONS

■ Generally, patients with basilar skull fractures do not require treatment

other than pain medications, antiemetics, and observation.

■ Consider discharge for adults with simple linear fractures who are neuro-

logically intact.

■ Meningitis may occur following basilar skull fracture, and requires anti-

biotics and neurosurgical consultation. There is no consensus on the use

of prophylactic antibiotics.

Fracture of Skull Convexity

EXAM

■ Evaluate for lacerations, exposed, fractured, or depressed bone.

■ Overlying hematomas or lacerations may indicate underlying fracture.

■ Look for pneumocephalus on CT.

TREATMENT

■ Operative repair is required for fractures depressed beyond one full thickness

of the skull because of increased likelihood of direct compression of the brain.

■ Antibiotics should be given to patients with open skull fractures.

TRAUMA

FIGURE 3.3. Subdural hematoma. Non-contrast head CT showing right subdural

hematoma (1) with collapse of the right ventricle and midline shift (2).

(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski JS. Emergency

Medicine:A Comprehensive Study Guide, 6th ed. New York: McGraw-Hill, 2004:1568.)

Nimodipine is used for

treatment of SAH from

spontaneous ruptured

aneurysm but not for

traumatic head injury.

CPP = MAP—ICP

Ideal CPP > 60 mmHg

Ideal MAP > 80 mmHg

Ideal ICP < 15 mmHg

In patients who have very low

GCS but no findings on CT,

consider diffuse axonal injury

(DAI) resulting from shearing

of axonal fibers.

GSWs to the head result in

cavitation injury three to four

times the bullet’s diameter.