Mike - I just want to drop a quick comment to say thank you. I haven't yet taken the National Registry exam, but until I found you on YouTube, bought your book, and signed up for this community, I felt overwhelmed and not very confident in my ability to learn all the material required to become a paramedic. But thankfully, you have a gift for teaching complex topics. Your book is crystal clear, your video explanations make sense, and your tests (with feedback) are really helping me remember important content. So I'm not yet posting anything in the "Wins" category but I fully expect to sometime later this year, in large part due to your curriculum. Huge thanks!!

Mike is inviting you to a scheduled Zoom meeting. If you're looking to do a medic prep with me, feel free to jump in! If you can't make it, no worries. I will record it. See you there. Topic: Medic Prep Time: Mar 23, 2026 09:00 AM Eastern Time (US and Canada) Join Zoom Meeting https://us02web.zoom.us/j/83640237364 Meeting ID: 836 4023 7364 --- One tap mobile +13052241968,,83640237364# US +13092053325,,83640237364# US Join instructions https://us02web.zoom.us/meetings/83640237364/invitations?signature=Te8dHvgzyRmaM2Wa9miDheNSnC3fBC4TObLWbJYbMq0

Basilar Skull Fracture What it is: Fracture at the base of the skull, often from significant blunt trauma. Classic Signs (MEMORIZE) Battle’s Sign - Bruising behind the ear (mastoid area) - Indicates basilar skull fracture, NOT just soft tissue injury Raccoon Eyes - Periorbital ecchymosis (bruising around both eyes) - Suggests skull base involvement CSF Leakage - Clear fluid from nose (rhinorrhea) or ears (otorrhea) - May see halo/ring sign NREMT Clinical Decision Point If you see: - Battle’s sign - Raccoon eyes - CSF leak → Assume basilar skull fracture Management - Airway with spinal precautions - Avoid nasopharyngeal airway (NPA) - Control bleeding - Rapid transport Test Pearl Battle’s sign alone = basilar skull fracture until proven otherwise Epidural Hematoma What it is: Bleeding between the skull and dura mater (often arterial) Classic Presentation - Brief LOC → lucid interval → rapid deterioration - Severe headache - Vomiting - Decreasing LOC Why it’s dangerous: - Rapid increase in intracranial pressure (ICP) - Can lead to herniation and death Management - Airway control - Oxygenation (avoid hypoxia) - Prevent hypotension - Rapid transport to trauma center Test Pearl “Talk and die” = epidural hematoma Increased ICP & Cushing’s Response What is Cushing’s Response? A late sign of increased ICP and impending herniation Classic Triad (MEMORIZE) - Hypertension (widened pulse pressure) - Bradycardia - Irregular respirations Early Signs of Increased ICP - Altered mental status - Headache - Nausea/vomiting - Restlessness - Pupillary changes Causes (testable) - Traumatic brain injury - Hemorrhagic stroke - Intracranial bleeding (epidural, subdural) Management Priorities - Maintain oxygenation and ventilation - Avoid hypotension (SBP critical for perfusion) - Elevate head if appropriate - Rapid transport Test Pearl Cushing’s = LATE → patient is about to herniate