Fractures of the skull include the cranium, face, and base of the skull. These fractures can be superficial or penetrate deeper into the cranial cavity. They put the patient at risk for cranial nerve damage, cerebral edema, meningitis, and bleeding on the brain. All of these things can lead to increased ICP, herniation, and brain death.
Fractures of the skull require a massive force of trauma to the face or head. This is seen commonly in assaults, motor vehicle collisions, or falls
Prevent long-term neurological damage, protect airway, and preserve the patient’s functional ability.
Monitor airway and respiratory status
Swelling in face or in brain can cause compromised airway or breathing. Cranial nerve damage may also impair swallowing.
Assess drainage for CSF, avoid nose blowing
Halo’s sign (yellow ring around blood spot on gauze) indicates a CSF leak from nose/ears or through a fracture. Nose blowing can cause a CSF leak or bleed.
Assess cranial nerve function
Facial fractures and basilar skull fractures carry a high risk of cranial nerve damage, including sensation to the face and ability to swallow.
Assess LOC and ICP/CPP with frequent neuro checks.
CPP = MAP – ICP (monitor hemodynamics)
Neurological changes related to increasing ICP may be subtle or may occur rapidly. Frequent detailed neuro checks allow changes to be recognized quickly so that interventions can be initiated.
Perform interventions to minimize ICP:
Assess swallow prior to giving anything by mouth – involve Speech Therapy as appropriate
Due to muscle weakness, patients may experience difficulty swallowing. It may be appropriate to have ST assess for appropriate interventions to prevent aspiration.
Administer analgesics as ordered
Severe pain can cause increased ICP, among other complications. Give pain medications as ordered and as needed.
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