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jueves, 6 de junio de 2019

Basilar Skull Fracture

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emDocs - June 6, 2019 - Authors: Pillai S and Desai S
Edited by: Koyfman A and Long B
..."Pearls and Pitfalls:
  • Battle sign and raccoon’s eye may be delayed 6-12 hours or not present with BSF.
  • Hemotympanum is typically first finding.
  • Most complications of BSF like CSF leak, cranial nerve deficits, and sequelae of carotid/vertebral artery injury arise late and present after 48 hours.
  • Consider abuse in elderly and children.
  • Consider meningitis if prolonged CSF leak.
  • No evidence for prophylactic antibiotics regardless of CSF leak.
  • Consider CTA to evaluate for carotid artery injury regardless of cervical fracture.
  • Missed CVI can lead to permanent neurologic sequelae or mortality in up to 50% cases.
  • Avoid nasogastric intubation, nasopharyngeal suction / airway, and NIPPV if potential BSF."