A 6-year-old child fell approximately 10 feet from a treehouse, landing on his head. He is conscious but confused, with a GCS of 13. You observe clear fluid leaking from his left ear and bruising behind his left ear. Respirations are 20 breaths/minute and regular, pulse is 90 bpm, and blood pressure is 100/60 mmHg. Which of the following prehospital interventions is CONTRAINDICATED for this patient?
- APacking the ear canal with sterile gauze.
- BApplying a cervical collar.
- CAdministering high-flow oxygen.
- DSecuring the child to a long backboard.
Show answer & explanationAnswer & explanation
Correct answer: A. Packing the ear canal with sterile gauze.
The clear fluid leaking from the ear, combined with bruising behind the ear (Battle's sign), strongly indicates a basilar skull fracture with cerebrospinal fluid (CSF) leakage. Packing the ear canal could prevent the drainage of CSF and potentially introduce infection into the brain, making it a contraindicated intervention.
Why the other options are wrong
- B. Given the mechanism of injury (fall from height) and head trauma, cervical spine immobilization with a collar is indicated to protect against potential spinal injury.
- C. High-flow oxygen is appropriate for any patient with head trauma or altered mental status to ensure adequate cerebral oxygenation.
- D. Securing the child to a long backboard is appropriate for spinal immobilization following a significant mechanism of injury, especially with altered mental status or suspected head/spinal trauma.
Basilar Skull Fracture Prehospital Care
A basilar skull fracture involves a fracture at the base of the skull. Key signs include Battle's sign (bruising behind the ear), raccoon eyes (periorbital bruising), and CSF leakage from the ears (otorrhea) or nose (rhinorrhea). Management focuses on spinal immobilization, oxygenation, and avoiding interventions that could introduce infection.
- CSF leakage is a hallmark sign.
- Preventing infection is critical.
- Spinal precautions are necessary.
Memory trick: Don't Block the Brain's Drain, or You'll Invite Pain.