0071643192.pdf

HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

■ May require 16f Foley with clamp to hold in place or two chamber intranasal

balloons

■ With few exceptions, patients with posterior nasal packing should receive

broad-spectrum antibiotics and be admitted.

■ Posterior nasal packing should be left in place for 72–96 hours.

COMPLICATIONS

■ Sinusitis

■ Necrosis of septum and soft palate

■ Respiratory suppression with hypoxia, hypercarbia due to nasopulmonary

reflex

■ Bradycardia, dysrhythmias, and aspiration have been reported with poste-

rior packing.

Foreign Body

A foreign body presents with unilateral foul-smelling discharge. There are

various methods to extract, but if you cannot do it safely, discharge with ENT

referral within 24 hours.

FACIAL TRAUMA

Fifty percentof facial trauma is caused by MVCs. This contribution has

decreased with the use of seatbelts and airbags. After assessing the ABCs, the

goals are to identify fractures (10% incidence of associated C-spine fractures),

assess neurologic injuries, and identify/treat threats to vision.

Nasal Fracture

Nasal fracture is the most common maxillofacial fracture (#2 is mandible frac-

ture). It is usually secondary to blunt trauma (see Figure 14.7A).

SYMPTOMS/EXAM

■ Evaluate the nasal bones and facial area for swelling, tenderness, mobility,

crepitus, deformity, and step-offs.

■ Evaluate septum for hematoma, checking for a “dark clot” (see Figure 14.7B).

DIAGNOSIS

■ A clinical diagnosis

■ X-rays are insensitive and unnecessary for simple nasal fractures.

TREATMENT

■ Ice to reduce swelling

■ Follow up with plastics or ENT in a few weeks for cosmetic issues.

■ Discharge home with pain medications, intermittent ice application, and

nasal decongestants.

■ Septal hematoma: I+D/pack, Doyle splint, or a bilateral pressure pack

Admit patients with posterior

nasal packing.

Evaluate all patients with

nasal trauma for septal

hematoma. Drain septal

hematomas to prevent

abscess formation and

cartilage necrosis.