Basilar Skull Fracture and Cerebrospinal Fluid (CSF) Leaks (Nursing)

00:00 But first of all, it's time for a question.

00:02 Do you know what these two signs are called? The sign on the left and the sign on the right.

00:08 Pause the video for just a moment and force yourself to write something down, your best guess.

00:20 Okay, welcome back.

00:22 Did you get it? Raccoon eyes and battle sign.

00:26 Raccoon eyes are here. Battle sign is here.

00:30 If your patient presents with double black eyes like that, that's why we call it raccoon eyes, it could be a late sign of an anterior fossa fracture.

00:39 That just tells you the location of the basilar skull fracture.

00:42 If the big bruising sign is around the ear, below the ear, it could be a delayed sign of a middle fossa fracture.

00:50 So the eyes is anterior fossa.

00:53 The ears is the middle fossa fracture.

00:55 Now let me give you a little tip.

00:57 This usually shows up in a nursing school exam somewhere sometime.

01:02 So make sure you highlight this.

01:04 Plus, if you ever see a patient with one of these signs, this is a no-brainer that every nurse should recognize what this means.

01:11 Now I've got another question for you.

01:13 Why wouldn't you want to insert an NG tube in a patient with a suspected basilar skull fracture? Here's some homework for you.

01:22 I want you to pause the video, and I just want you to Google "NG tube and basilar skull fracture," and look for images on Google, and that will give you a very clear picture on why you don't want to do that.

01:38 Okay.

01:39 Gosh, are you scarred for life after looking at those pictures? You see the problem if someone has a basilar skull fracture and you insert an NG tube, a nasogastric tube, you could actually run that NG tube up into their brain.

01:56 So you probably saw some pretty graphic pictures when you look that up.

01:59 So always know if someone has a battle sign or you see around their eyes, the bruising around their ears, don't put an NG tube.

02:07 If you have an order, stop, contact the health care physician.

02:11 Let them know these is what you're seeing why you don't want to put that NG tube in.

02:15 Okay, now when it comes to CSF leaks, this means cerebrospinal fluid leaks.

02:22 This is one of the other telltale signs of a basilar skull fracture.

02:27 So you want to watch for drainage coming from either the nose or the ears.

02:31 If it comes from the ears, that's otorrhea.

02:33 So "oto" meaning ear, "rhea" meaning, "Yeah, that's dripping out there," right? So if it's coming from the ear, that's another sign of a middle fossa fracture.

02:43 Now if you have rhinorrhea, if you know this patient has fluid dripping from their nose, that's the sign of an anterior fossa fracture.

02:50 So, you don't want to overlook.

02:51 If someone's showing you these signs and they're dripping fluid, it might not be allergies.

02:56 You're going to want to check and see if that's actually cerebral spinal fluid.

03:00 So, as Nurse Natalie says, "How can you be sure?" Well, we've got some tests for that.

03:06 You can take that fluid and test it for glucose.

03:08 Cerebral spinal fluid is usually about two-thirds the level of the patient's blood glucose.

03:14 Another way, if it's mixed with blood, if what's draining out of the ear or draining out of the nose, if it's mixed with blood, if you put a drop of it on some type of white fabric, we call it the Halo test, so if it's mixed with blood, take a drop of that, put it on a white sheet, and if you see a layering with blood on the inside and fluid the outside, that's called the halo test.

03:37 That would let us know that this is likely cerebral spinal fluid, another sign of basilar skull fracture.

03:44 So, if your patient is showing you any of these signs, you want to let the healthcare provider know.

03:49 "Hey, I think we've got a potential problem here." Those of you heading to ER are most likely to see this, but you could be out on a ball field, you could be at a site of a motor vehicle accident, and see similar things.

04:02 So, every nurse needs to know these signs.

04:04 You can help provide the safe and most effective care for all patients.