You receive a patient in the ED who fell and hit their head. You walk into your patient's room to do an assessment. You notice they have bruising behind their ears and around their eyes. What are you most concerned about?

A. Skull fracture is correct because bruising behind the ears (Battle’s sign) and around the eyes (raccoon eyes) are classic indicators of a basal skull fracture. These bruises result from bleeding from the fracture site tracking into surrounding soft tissues. Basal skull fractures carry significant risks, including cerebrospinal fluid (CSF) leak, intracranial hemorrhage, and cranial nerve injury, and require urgent assessment and monitoring. B. Mastoiditis is incorrect because this is an infection of the mastoid bone, usually secondary to untreated middle ear infections. While bruising is near the mastoid area, mastoiditis does not cause Battle’s sign after trauma. C. Subdural hematoma is incorrect because although head trauma can cause subdural hematomas, the presence of periorbital and postauricular bruising specifically indicates a skull fracture, not a hematoma itself. Subdural hematomas require imaging for diagnosis and may accompany a skull fracture but are not diagnosed by bruising patterns alone. D. Concussion is incorrect because a concussion is a functional brain injury without structural damage. While it can occur with head trauma, raccoon eyes and Battle’s sign are not typical of concussion; they indicate structural skull damage.