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B Penetrating mechanism
Risk factors
A None
B History of loss of consciousness
B Anticoagulation (aspirin, warfarin, etc.)
B Age greater than sixty years
A = Do not evacuate
B = Consider evacuation
C = Evacuate immediately (presence of any parameter)
GCS = GLASGOW COMA SCALE
Signsofabasilarskullfracture,suchasbleedingordrainageofcerebrospinalfluidfrom
the ears or nose, also mandate early antibiotic treatment. Ideally, antibiotics should be
administered intravenously, but if this is not feasible, medications by mouth should be
administered with only small volumes of water.
Due to the risk of aspiration, individuals with a suspected brain injury must be kept
sober and take nothing by mouth (NPO) until reaching a hospital. Keeping individuals
NPO also facilitates any required neurosurgical intervention.
FACIAL INJURIES
Soft-Tissue Injuries
The tissues of the face have a greater blood supply than most other areas, tend to heal
faster, and have greater resistance to infection. Tags of skin around facial wounds should
not be trimmed away unless they are so badly damaged that survival is obviously impos-
sible. Many such skin fragments can be saved and may reduce the need for skin grafting at
a later date. Preserving these fragments may also reduce scarring.
Fractures
Facial fractures are uncomfortable but, except for lower jaw fractures, do not require
splinting and seldom interfere with locomotion. Delayed treatment is often the preferred
method of caring for hospitalized individuals with such injuries. Therefore, treating facial
fractures is rarely an urgent problem. However, such fractures can make the maintenance
of an open airway quite difficult, particularly for unconscious individuals. A fractured jaw
may permit the tongue to drop back into the throat, completely obstructing the passage of
air. Extensive fractures of the nose and adjacent bones can allow the nasal air passages to
collapse.
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