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

by Rhonda Lawes

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    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.

    About the Lecture

    The lecture Basilar Skull Fracture and Cerebrospinal Fluid (CSF) Leaks (Nursing) by Rhonda Lawes is from the course Brain Injuries (Nursing) .

    Included Quiz Questions

    1. Basilar skull fracture
    2. Linear skull fracture
    3. Depressed skull fracture
    4. Diastatic skull fracture
    1. Nose
    2. Ears
    3. Mouth
    4. Eyes
    5. Throat

    Author of lecture Basilar Skull Fracture and Cerebrospinal Fluid (CSF) Leaks (Nursing)

     Rhonda Lawes

    Rhonda Lawes

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