A blunt head injury patient presents with blood-tinged drainage from the ear and bruising behind the ear. The most appropriate treatment includes:

• A. Control drainage from the ear and immobilize entire spine.
• B. Elevate the lower extremities and provide immediate transport.
• C. Immobilize spine, administer oxygen, and monitor for vomiting.
• D. Apply high-flow oxygen and pack the ear with sterile gauze pads.

Answer: (C)

In blunt head injuries, blood-tinged drainage from the ear with bruising behind the ear strongly suggests a basilar skull fracture. The priority is to protect the brain and the spine while ensuring adequate oxygenation. Immobilize the cervical spine to prevent any movement that could worsen injury, and provide high-flow oxygen to support brain tissue if the patient is not already hypoxic. Also, monitor for vomiting because it can signal increased intracranial pressure and poses a risk to the airway; be prepared to manage the airway if needed.

Avoid manipulating the ear or trying to seal or pack the ear, as a suspected CSF leak from a basilar skull fracture requires careful handling and avoidance of further contamination or irritation. In essence, treat as spinal injury with good oxygenation and vigilant observation for signs like vomiting, then transport promptly.