Skull fracture

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Battle's sign - behind the ear	Infant skull fracture	Skull fracture	Skull fracture
Skull of an adult

Basilar skull fracture; Depressed skull fracture; Linear skull fracture

1. Check the airways, breathing, and circulation. If necessary, begin rescue breathing and CPR.

2. Avoid moving the victim (unless absolutely necessary) until medical help arrives. Instruct someone to call 911 (or the local emergency number) for medical assistance.

3. If the victim must be moved, take care to stabilize the head and neck. Place your hands on both sides of the head and under the shoulders. Do not allow the head to bend forward or backward, or to twist or turn.

4. Carefully check the site of injury, but do not probe in or around the site with a foreign object. It can be difficult to know if the skull is fractured or depressed (dented in) at the site of injury.

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5. If there is bleeding, apply firm pressure with a clean cloth to control blood loss over a broad area.

6. If blood soaks through, do not remove the original cloth. Instead, apply additional cloths on top, and continue to apply pressure.

7. If the victim is vomiting, stabilize the head and neck (as outlined in number 3, above), and carefully turn the victim to the side to prevent choking on vomit.

8. If the victim is conscious and experiencing any of the previously listed symptoms, transport to the nearest emergency medical facility (even if the patient does not think medical assistance is necessary).

• Do NOT move the victim unless absolutely necessary -- head injuries may be associated with spinal injuries.
• Do NOT remove protruding objects.
• Do NOT allow the victim to continue to engage in physical activities.
• Do NOT forget to observe the victim closely until medical help arrives.
• Do NOT give the victim any medications before consulting a physician.
• Do NOT leave the victim alone, even if there are no complaints or obvious injuries.

• There are problems with breathing or circulation.
• Direct pressure does not stop bleeding from the nose, ears, or wound.
• There is drainage of clear fluid from the nose or ears.
• There is facial swelling, bleeding, or bruising.
• There is an object protruding from the skull.
• The victim is unconscious, is experiencing convulsions, has multiple injuries, appears to be in any distress, or is not lucid.

Review Date: 01/14/2010
Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).