(2) Fluid from the ears and nose should be checked for the presence of
spinal fluid. Soak up a small amount of drainage from the ears or nose with a 4 x 4
gauze square. Cerebral spinal fluid will form a ring around the blood.
Any trauma above the clavicle (collarbone) should suggest cervical
(4) Consider that the patient may have cervical spine injury and immobilize
his head and neck if:
(a) The mechanism of injury suggests violent action to the spine.
(b) The patient has a severe head injury.
Injury to the patient resulted in:
1 Loss of consciousness.
2 Markedly altered level of consciousness.
3 Display of specific signs of neurological deficit (motor or
e. Special Considerations. Be aware that:
(1) Drugs and alcohol will frequently change the level of consciousness and
cloud significant signs and symptoms of the trauma patient.
(2) Altered respiratory patterns may be caused by other injuries and by
uncorrected hypovolemia (markedly diminished blood volume).
Metabolic abnormalities can alter respiratory function.
(4) Blood pressure elevation may be caused by pain, anxiety, or preexisting
(5) Only at the terminal stages of head injury does the patient exhibit
hypotension as the result of head injury itself.
(6) Assume a patient with low blood pressure is hemorrhaging elsewhere
and treat for shock.