What is the recommended management for suspected cerebrospinal fluid leakage on scene?

• A. Apply direct pressure to stop the leak
• B. Clean away fluid, do not apply pressure
• C. Cover with a tight wrap
• D. Seek rapid transport without managing the leak

Answer: (B)

On-scene care for suspected cerebrospinal fluid leakage after head trauma focuses on protecting the airway, preventing contamination, and avoiding actions that could worsen the injury, while arranging rapid transport. CSF leakage suggests a skull fracture, so you don’t want to apply pressure to the leak or seal it tightly, which could push fluid or debris or mask ongoing issues.

Gently wipe away the visible drainage with a sterile gauze and avoid pressing on the leak site. This helps keep the area clean for assessment and reduces the chance of contamination without exerting force on fragile tissues. Use a loose, sterile dressing to absorb drainage without compressing the area. Do not insert packing into the nose or ears, and avoid attempts to stop the leak with tight dressings. Also discourage actions that can raise pressure or increase flow, such as nose blowing.

Keep the patient as comfortable as possible and transport promptly, monitoring for changes in mental status or respiratory status.