7d • Paramedic Talk
Trauma High-Yield Concepts for NREMT
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
Neurogenic Shock vs Spinal Shock
Neurogenic Shock
What it is:
Loss of sympathetic tone from spinal cord injury (usually above T6)
Key Findings (MEMORIZE)
- Hypotension
- Bradycardia (UNIQUE—opposite of other shock states)
- Warm, dry skin
Why it happens:
- Loss of vasoconstriction
- Loss of sympathetic cardiac stimulation
Management
- IV fluids
- Consider vasopressors
- Spinal precautions
Spinal Shock
What it is:
Temporary loss of motor, sensory, and reflex function
Key Findings
- Paralysis
- Loss of reflexes
- Flaccid muscles
Important Distinction
- Neurogenic shock = hemodynamic problem
- Spinal shock = neurologic deficit
Test Pearl
If you see bradycardia + hypotension → neurogenic shock
Occlusive Dressing (BLS before ALS)
When to use:
- Open chest wound (“sucking chest wound”)
What it does:
- Prevents air from entering the chest cavity
- Reduces risk of tension pneumothorax
Proper Application
- Apply occlusive dressing immediately (BLS skill)
- Prefer vented dressing if available
- If non-vented → monitor for tension pneumothorax
NREMT Priority Concept
BLS before ALS
Even as a paramedic:
- You must recognize that basic interventions come first
Test Scenario Trap
If options include:
- Needle decompression
- Intubation
- Occlusive dressing
Correct FIRST step = occlusive dressing
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Trauma High-Yield Concepts for NREMT
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