NREMT Emergency Medical Technician (EMT) Cognitive ExamTraumaMedium
A 6-year-old child fell approximately 10 feet from a treehouse, landing on his head. He is conscious but disoriented, and you observe clear fluid leaking from his left ear. What should be your primary concern and immediate management strategy?
- AAdministering oral glucose to address potential altered mental status.
- BImmobilizing the child's head and spine, and administering high-flow oxygen.
- CControlling the fluid leakage from the ear with a sterile dressing.
- DApplying direct pressure to the ear to stop the fluid leakage.
Show answer & explanationAnswer & explanation
Correct answer: B. Immobilizing the child's head and spine, and administering high-flow oxygen.
Clear fluid leaking from the ear after head trauma, especially with altered mental status, is highly suggestive of a basilar skull fracture and cerebrospinal fluid (CSF) leakage. The primary concern is protecting the brain and spinal cord, making spinal immobilization and oxygen administration critical.
Why the other options are wrong
- A. While altered mental status can be due to hypoglycemia, the mechanism of injury and clear fluid leakage point to a severe head injury, making glucose administration secondary and potentially inappropriate without further assessment.
- C. While a sterile dressing is appropriate for the fluid, controlling the leakage is secondary to spinal immobilization and oxygen.
- D. Applying direct pressure to the ear is contraindicated as it can increase intracranial pressure and force brain matter or CSF back into the cranial vault.
Basilar Skull Fracture Prehospital Care
A fracture at the base of the skull, often indicated by CSF leakage (clear fluid) from the ears or nose, 'raccoon eyes', or Battle's sign.
- High suspicion with clear fluid leakage from ears/nose after head trauma.
- Primary concern is protecting the brain and spinal cord.
- Do NOT pack or apply direct pressure to the leakage site.
Memory trick: Clear fluid from the ear, spinal immobilization is near, oxygen high, to the trauma center we steer.