Bruising around the eyes

[quiet_app9]

We were dispatched to a 22-year-old female at a group home after staff reported facial bruising. She had purplish discoloration around both eyes, mostly the lids and under-eye area. She's like having raccoon eyes. She was a bit groggy, complained of a dull headache and some eye pain, pupils were equal and reactive.

Staff said she hit herself earlier in the day with a metal thermos, mostly on the top of her head. Swelling on her forehead and nose had already started to fade. She refused transport and was firm about staying put.

I know periorbital bruising can look dramatic, but in this case, it didn't seem like a basilar skull fracture. Still, the lethargy and mechanism had me second-guessing. Would you push harder for hospital eval, or monitor and document?

 

[Cod3Blu3Runn3r]

Even though the patient has raccoon eyes and doesn't want to go, I really think they should get checked out at the hospital to make sure there's no head injury, based on how they're acting and what's going on. Make sure to write everything down in detail

 

[poutin3]

@quiet_app9 Absolutely push for a hospital evaluation. The raccoon eyes aren't just cosmetic bruising, you know. they're a classic, delayed sign of a basilar skull fracture.
The fact that she hit the top of her head with a blunt object and the bruising appeared later is a huge red flag for blood tracking down from the base of the skull.
The grogginess, even without a major GCS change, is a change in her mental status and a sign that her neurological function is not baseline. This is not a 'monitor and document' situation