Nasal emergencies Flashcards
What are some common causes of nasal trauma?
Fights
Sporting injuries
Falls
What are some important history taking questions in nasal trauma?
- When trauma occured
- Loss of consciousness
- Epistaxis
- Breathing
What are some possible signs of nasal trauma?
- Bruising, swelling
- Tenderness
- Deviation
- Epistaxis
- Infraorbital sensation
- Cranial nerve examination
What are some possible risks of septal haematoma?
- Causes infarction of nasal cartilage
- May cause nasal collapse
- Can get infected, which can spread into the cranial cavity
How is nasal fracture diagnosed?
Clinical diagnosis based on nasal deviation
What is shown?
Septal haematoma
How is nasal trauma managed?
- Review nasal fracture in ENT clinic 5-7 days post-injury
- Consider digital manipulation in < 3 weeks
What are some possible complications of nasal trauma?
- Epistaxis - particularly anterior ethmoid artery
- CSF leak, meningitis
- Anosmia (Cribriform plate fracture)
- Nasal bone fractures and cartilage dislocation
- Septal haematoma
What are the 3 regions of the nasal pyramid?
What is epistaxis?
Nose bleed
What are some local causes of epistaxis?
- Idiopathic
- Trauma
- Foreign bodies
- Inflammation
- Tumour
What are some systemic causes of epistaxis?
- Drugs - e.g. Warfain, aspirin
- Clotting abnormalities
- Liver disease
- Haemophilia
- Leukaemia
- Thrombocytopaenia
- Arteriosclerosis
- Hereditary haemorrhagic telangectasia
- Systemic inflammatory conditions
- Wegner’s granulomatosis (GPA)
- Hypertension - causes prolonged bleeding but not primary cause of epistaxis
What type of vasculitis causes epistaxis?
GPA (Granulomatosis with polyangiitis) - Wegner’s granulomatosis
What is the most common site of bleeding in the nose?
Little’s area (Keisselbach’s plexus)
What arteries anastamose at Little’s area?
Anterior ethmoid
Posterior ethmoid
Sphenopalatine
Great palatine
Superior labial
What is the first aid management of epistaxis?
- Pinch fleshy anterior part of nose
- Lean forward
- Spit out into a bowl
- Ice pack compression
What are the secondary care management options for epistaxis?
- Resuscitation if necessary
- Topical vasoconstrictor
- Anterior rhinos copy to investigate source
- Silver nitrate cautery of anterior bleeding point
- Nasal packing (Rapid rhino) to compress
- Sphenopalatine artery ligation (Endoscopic)
- Systemic treatment
What are some systemic therapies for epistaxis?
- Tranexamic acid
- Reversal of effect of anticoagulants
- Correction of clotting abnormalities
- Platelet transfusion
- Treatment of hypertension
What is shown?
Nasal packing (Rapid rhino)
How are most foreign bodies in the nose managed?
Can usually wait until urgent clinic for removal
What object requires immediate removal from the nose?
Batteries
How are live animals stuck in the nose treated?
Drown with oil, can be removed next day
