Good afternoon, I’m happy to share that I passed my NREMT three days ago, and Rescue Academy played a huge role in helping me prepare. I strongly encourage everyone to make the most of all the resources available—use every content section and don’t skip anything. It really makes a difference. Best of luck to all of you. You’ve got this!

Basilar Skull Fracture What it is: Fracture at the base of the skull, often from significant blunt trauma. Classic Signs (MEMORIZE) Battle’s Sign - Bruising behind the ear (mastoid area) - Indicates basilar skull fracture, NOT just soft tissue injury Raccoon Eyes - Periorbital ecchymosis (bruising around both eyes) - Suggests skull base involvement CSF Leakage - Clear fluid from nose (rhinorrhea) or ears (otorrhea) - May see halo/ring sign NREMT Clinical Decision Point If you see: - Battle’s sign - Raccoon eyes - CSF leak → Assume basilar skull fracture Management - Airway with spinal precautions - Avoid nasopharyngeal airway (NPA) - Control bleeding - Rapid transport Test Pearl Battle’s sign alone = basilar skull fracture until proven otherwise Epidural Hematoma What it is: Bleeding between the skull and dura mater (often arterial) Classic Presentation - Brief LOC → lucid interval → rapid deterioration - Severe headache - Vomiting - Decreasing LOC Why it’s dangerous: - Rapid increase in intracranial pressure (ICP) - Can lead to herniation and death Management - Airway control - Oxygenation (avoid hypoxia) - Prevent hypotension - Rapid transport to trauma center Test Pearl “Talk and die” = epidural hematoma Increased ICP & Cushing’s Response What is Cushing’s Response? A late sign of increased ICP and impending herniation Classic Triad (MEMORIZE) - Hypertension (widened pulse pressure) - Bradycardia - Irregular respirations Early Signs of Increased ICP - Altered mental status - Headache - Nausea/vomiting - Restlessness - Pupillary changes Causes (testable) - Traumatic brain injury - Hemorrhagic stroke - Intracranial bleeding (epidural, subdural) Management Priorities - Maintain oxygenation and ventilation - Avoid hypotension (SBP critical for perfusion) - Elevate head if appropriate - Rapid transport Test Pearl Cushing’s = LATE → patient is about to herniate