Battle's Signs

[medstudent30]

I had a call the other day at work that was called in as a "Possible Subdural Hematoma" (per local nursing home). Upon examination of the patient, my partner and I found bruising around the ear. I have been in EMS for about 10 years and have never seen Battle's Signs. Just out of curiosity from other EMS professionals here, would you consider that Battle's Signs. It was a medium brown in color, it didn't have the black and blue appearance of a fresh bruise, or the light brown/green of an older bruise. [/font:543c4e46f6]

[chbare]

Older contusions can take on a brown to tan color. I have seen postauricular bruising on many patients. This may indicate a fracture to the base of the skull. We must be careful; however, not to diagnose based on one sign. We have all seen simple facial injuries result in periorbital contusions.

Take care,

chbare.

[AZCEP]

Was it on both sides, or just the one?

It's not really a matter of what you name it, if you see bruising behind the ears, Battle's sign it is. If you see it behind only one, you might call it something else. ( :wink: chbare)

Following a traumatic event with the energy transmission strong enough to cause the bruising, call it a "boo-boo", or an "OWIE", we should all have a pretty good idea of what you are trying to describe.

[chbare]

AZCEP, good call. The original post does seem to indicate the finding was isolated to one ear.

Take care,

chbare.

[Cookie]

I think a red flag should have gone up here, and seeing how its a nursing home, two red flags. I was taught that Battle's sign is seen several days following a basilar skull fracture. There may have been bloody drainage from the ear immediately after the fracture occurred and possibly nobody noticed.

[Just Plain Ruff]

Skull Fractures

Isolated linear nondepressed fractures with an intact scalp are common and do not require treatment. However, life-threatening intracranial hemorrhage may result if the fracture causes disruption of the middle meningeal artery or a

major dural sinus. Depressed skull fractures are classified as open or closed, depending on the integrity of the overlying scalp. Although basilar skull fractures can occur at any point in the base of the skull, the typical location is in the petrous portion of the temporal bone. Findings associated with a basilar skull fracture include hemotympanum, otorrhea or rhinorrhea, periorbital ecchymosis (“raccoon eyes”), and retroauricular ecchymosis (Battle's sign).

source: Emergency Medicine: A Comprehensive Study Guide, Companion Handbook (September 1, 2001): by David M. Cline, John Ma, O. John Ma, Gabor Kelen, Steven Stapczynski By McGraw-Hill Education - Europe