EM Quick Hits Video on Management of Nasal Fractures with Leeor Sommer
Nasal Fracture management in the Emergency Department
Clinical Assessment
- Always remember to assess for septal hematoma, which if unrecognized, can result in necrosis to the nasal cartilage, cosmetic deformities, and nasal perforation
- Assess the patient from 2 planes (above and in front) to identify subtle deformities/deviation
- Ask the patient and their entourage whether the nose appears different from baseline
Diagnosis
- Nasal fracture is a clinical diagnosis
- For the majority of isolated nasal injuries, there is little role for imaging as it does not alter management in non-displaced fractures, and deviated cartilage will not appear on X-rays anyway
- In patients who may require open reduction of a nasal fracture, defer the decision to perform a CT scan to the specialist who will be performing the surgery
Management
- Regional anesthesia with infraorbital and external nasal nerve block OR procedural sedation
- Closed reduction of nasal fractures video
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