Skull Fracture

WHAT YOU SHOULD KNOW

A break in the protective bone that forms the skull is always a serious emergency. Head injury is the leading cause of death in males under 35 years old.

Causes

A skull fracture is caused by a severe blow to the head.

Signs/Symptoms

A skull fracture typically causes pain and swelling or deformity of the skull; bruising or discoloration at the site of the injury, behind the ear, or around the eyes and nose; profuse bleeding from the scalp if the skin is broken; unequal pupils; and blood or clear, watery fluid leaking from the ears or nose. If the victim also sustains brain damage, these symptoms may be accompanied by drowsiness or confusion, vomiting and nausea, blurred vision, irritability, headache, memory lapses, and loss of consciousness.

Care

If the edges of the fracture remain aligned, the doctor will probably allow it to heal on its own without treatment. Surgery is required only if there are bone fragments pressing against the brain or the injury has pushed the bones out of alignment. Treatment is aimed at alleviating any damage the fracture may have caused to the brain.

Many people follow the “RICE” rule in caring for this type of injury. This is an acronym for four key components of treatment: Rest, Ice, Compression, and Elevation.

Risks

Various types of brain damage are the greatest danger. The most serious threat is hematoma—a pool of blood that collects and puts pressure on the brain. This can lead to permanent brain damage or even death, depending on the extent of the injury and the speed with which it's relieved.

Swelling of bruised or lacerated brain tissue is also a major peril, since the pressure can lead to paralysis or coma. Fractures at the base of the skull can tear the meninges—the layers of tissue that enclose the brain—allowing the cerebrospinal fluid that circulates between the brain and the meninges to leak through the nose or ear.

If the skin over the fracture is broken, infection is also a danger. Infections inside the skull can lead to severe brain damage.

WHAT YOU SHOULD KNOW

While awaiting emergency care, take these first-aid measures:

• Do not take any medications, including over-the-counter acetaminophen or aspirin until the extent of your injury is determined.
• Place an ice pack on the injury. Put ice chips or cubes in a plastic bag or wrap them in a thin towel. Ice the injured area for 30 minutes, then remove the ice and allow the area to warm for about 15 minutes. Continue the icing and warming cycle for three hours. Do not put ice directly on the skin.
• Rest calmly and quietly for several hours after the injury to promote faster healing and avoid further injury, bleeding, and pain.
• Elevate the head for several hours after the injury.
• If the site of the injury is bleeding, wrap the head with a cloth to compress the injury and stop the bleeding.

Seek Care Immediately If...

You've sustained any sharp blow to the head or begin to experience symptoms of brain damage such as profuse bleeding, vomiting, or blurred vision. THIS IS AN EMERGENCY. Call 911 or 0 (operator) to get to the nearest hospital or clinic. Do not drive yourself!

IF YOU'RE HEADING FOR THE HOSPITAL...

What to Expect While You're There

• Vital Signs: These include your temperature, pulse, blood pressure, and respiration. A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm. These tests may be performed hourly.
• IV: A tube placed in your vein for giving medications, such as antibiotics, painkillers, or liquids. It will either be capped or have tubing connected to it.
• CT Scan: Computerized axial tomography, a type of x-ray also know as a CAT scan or CT scan, takes a picture of the brain to help doctors assess any damage.
• MRI: Magnetic resonance imaging produces highly detailed snapshots of sections of the brain and spinal cord that help doctors assess bleeding, swelling, and other irregularities in the brain. For this picture, you will have to lie on a narrow bed that slides into the scanner.
• Electroencephalogram (EEG): This is a tracing of the electrical activity in the brain. To sense the activity, tiny wires (electrodes) will be placed on your head with paste.
• Pulse Oximeter: This is a clip placed on your ear, finger, or toe and connected to a machine that measures the oxygen in your blood.
• Neuro Signs: The doctor will check your eyes, test your memory, and see how easily you can be awakened.
• Blood: Taken from a vein in your hand or the bend in your elbow to be used for testing. Oxygen and other gases dissolved in your blood will also be evaluated, so additional samples may have to be drawn from the wrist, elbow, or groin.
• Surgery: May be required to alleviate any pressure the injury is putting on the brain.

After You Leave

• Follow a liquid-only diet for the first 24 to 48 hours after the injury until the danger of complications passes. Drink plenty of fluids to avoid dehydration.
• Have someone stay with you for the first 24 to 48 hours. They should wake you every hour for the first 24 hours and ask you simple questions, such as “What is your name?” and “Where are you?”
• Get plenty of bed rest. Do not resume your normal activities until you feel up to them. This may take several weeks.
• Take your medications exactly as prescribed. Do not stop taking your medications until your prescription runs out, even if you are feeling better.

Seek Care Immediately If...

• You begin having seizures.
• You experience muscle weakness or paralysis.
• You experience severe confusion.

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