Skull Fractures

The mechanism of injury is clearly head trauma. All patients with a skull fracture should be evaluated for a concussion, increased ICP, and a cervical spine injury, and treated accordingly. Not all patients with a skull fracture present with a loss of consciousness and not all skull fractures require surgery. Exercise caution during the physical exam to avoid compressing a fractured area and further damaging brain tissue. A fracture in conjunction with an overlying wound, or one that communicates with the paranasal sinuses or middle ear often leads to meningitis.

Skull Fracture S/Sx

• Obvious deformity ± scalp wound.
• Scalp hematomas with swelling that inhibits palpation of the underlying bone.
• ± CSF leaking from nose or ears.
  

 Skull Fracture Treatment

• Treatment of a skull fracture is independent of assessment & treatment of any concurrent brain (concussion or ICP) or spinal injury. Click here to read an article on traumatic brain injuries.
  
• Begin a Level 1 EVAC for a suspected or observed depressed skull fracture.

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