Following a blunt injury to the head, a 22-year-old female is confused and complains of a severe headache and nausea. On the basis of these signs and symptoms, you should be MOST concerned with the possibility of:

• A. Intracranial bleeding.
• B. Skull fracture.
• C. Airway compromise.
• D. Spinal cord injury.

Answer: (A)

A head injury with confusion, severe headache, and nausea points most strongly to intracranial bleeding. When bleeding occurs inside the skull, it increases pressure on the brain, which can rapidly worsen mental status and trigger severe headache and vomiting. This situation is an emergency because without quick assessment and treatment, brain injury can progress.

Skull fracture can accompany bleeding, but these symptoms are not specific to a fracture and the combination listed is more ominous for a hemorrhage inside the skull. Airway compromise would present with breathing difficulties or airway obstruction rather than predominantly neurological symptoms. Spinal cord injury would usually cause limb weakness, numbness, or loss of function below the level of the injury, not just confusion and headache.