What is the nursing priority when basilar skull fracture is suspected?

• A. Start high-flow oxygen only
• B. Administer diuretics to reduce pressure
• C. Avoid nasal intubation/nose blowing; prevent CSF leak; monitor for CSF leak; protect airway
• D. Perform nasal suctioning first

Answer: (C)

When basilar skull fracture is suspected, the priority is to protect the airway while preventing a CSF leak and the risk of CNS infection. The skull base is involved, and a CSF leak can occur through the nose or ears; nasal instrumentation or nose blowing can worsen or create a leak and allow bacteria to enter the CNS, increasing meningitis risk. Therefore, avoid nasal intubation or any nasal manipulation, and monitor for CSF leak (clear, sterile rhinorrhea that may test positive for beta-2 transferrin). If airway support is needed, secure the airway via an oral route and protect the airway. This approach directly targets preventing CSF leakage and infection while ensuring the airway is safeguarded. High-flow oxygen alone doesn’t address the leak; diuretics aren’t a frontline nursing priority for this scenario; nasal suctioning or other nasal procedures would raise the risk of worsening a CSF leak.