Question

Your patient is a 16-year-old centerfielder on his high school baseball team. He was injured when he and the left fielder collided trying to catch a fly ball. He is disoriented and is unable to tell you what happened. His vital signs are pulse 88, blood pressure 132/86, respiratory rate 16, and pupils equal. As you assess his head, you do not see any cuts or bleeding, but you feel a spongy, depressed area over his left ear. You should suspect:

A. skull injury.
B. closed head injury.
C. direct injury.
D. open head injury.

Answer 1

A 16-year-old patient with a spongy, depressed area over the left ear after a collision should be suspected of having a depressed skull fracture at the pterion, which is dangerous due to underlying arterial location that can cause a hematoma.

Step-by-step explanation:

Given the patient's symptoms of disorientation, inability to recall the incident, normal vital signs but with a spongy, depressed area over the left ear, we should suspect a skull injury, specifically a depressed skull fracture. This condition often occurs after a forceful blow to the head, which can cause a piece of skull to cave inwards toward the brain. The mentioned depression over the patient's left ear, a region known as the pterion, is a significant clinical concern because an artery that supplies the dura mater (a membrane that covers the brain) runs beneath this thin area of the skull. A fracture here may lead to a hematoma, where bleeding exerts pressure on the brain, possibly resulting in severe complications or even death if left untreated. Immediate medical attention and likely imaging (such as CT scan) would be necessary to assess the extent of the injury.