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Atlas of Emergency Medicine 4th Edition

Atlas of Emergency Medicine 4th Edition

Author: Kevin J. Knoop M.D. and Lawrence B. Stack M.D

Publisher: McGraw-Hill Education


Publish Date: May 30, 2016

ISBN-10: 0071797254

Pages: 1008

File Type: PDF

Language: English

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Book Preface

Clinical Summary

The skull “base” comprises the frontal bone, occiput, occipital condyles, clivus, carotid canals, petrous portion of the temporal
bones, and the posterior sphenoid wall. A basilar skull fracture is basically a linear fracture of the skull base. Trauma resulting in fractures to this area typically does not have localizing symptoms. Indirect signs of the injury may include visible
evidence of bleeding from the fracture into surrounding soft tissue, such as a Battle sign or “raccoon eyes.” Bleeding into other structures—including hemotympanum or blood in the sphenoid sinus seen as an air-fluid level on computed tomography (CT)—may also be seen. Cerebrospinal fluid (CSF) leaks may also be evident and noted as clear or pink rhinorrhea. If CSF is present, a dextrose stick test may be positive. The fluid can be placed on filter paper and a “halo” or double ring may be seen.

Management and Disposition

Identify underlying brain injury, which is best accomplished by CT. CT is also the best diagnostic tool for identifying the fracture site, but fractures may not always be evident. Evidence of open communication, such as a CSF leak, mandates neurosurgical consultation and admission. Otherwise, the decision for admission is based on the patient’s clinical condition, other associated injuries, and evidence of underlying brain injury as seen on CT. The use of antibiotics in the presence of a CSF leak is controversial because of the possibility of selecting resistant organisms.

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