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Although skull fracture is frequently indicative of a potentially serious and life-threatening condition, be aware that the real danger is damage to the brain itself. There may be fragments of bony skull causing pressure or compression on the brain (depressed fracture) and the resulting indentation of the skull may be missed as a result of swelling in the scalp. Therefore all injuries to the head should be treated with the utmost caution and suspicion, especially if any of the following signs of cerebral compression are present:
1. Vomiting, persistent headache or yawning.
2. Brief or partial loss of consciousness, or full unconsciousness.
3. Pupils of unequal sizes, which may enlarge and fail to constrict in response to light if compression increases. Also blood in the white of the eye (the cornea).
4. One-sided paralysis or weakness of the face or body.
5. Irregular or noisy breathing, becoming increasingly slower.
6. Slow, strong pulse.
7. High temperature and flushed face.
8. Leakage of watery blood or straw-colored fluid from the nose or ear.
An injury above chest level should be treated as a suspected spinal injury. In all cases, call 999 for an ambulance, monitor breathing and circulation and treat as for unconsciousness while awaiting the arrival of the ambulance.
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