Non-traumatic Conditions of the Nose
402 ENT emergencies
MANAGEMENT
1 Refer any patient with a grossly deformed or compound fracture, or a septal
haematoma to the ENT team.
(i) Refer more serious facial bone fractures to the maxillofacial
surgery team.
2 Otherwise, refer the patient to the ENT clinic within the next 5–10 days, if
the patient requests operative treatment to straighten the nose for cosmetic
reasons.Foreign body in the nose
DIAGNOSIS AND MANAGEMENT
1 This may be quite asymptomatic, or it may lead to a serosanguineous, offen-
sive, unilateral nasal discharge.
2 Attempt removal with a bent probe or pair of forceps if the object is easily
accessible in the anterior part of the nose, after the patient has vigorously
blown the nose (which may dislodge the object anyway).
3 However, refer immediately to the ENT team if removal is difficult, or a child
is uncooperative.
(i) Sudden posterior dislodgement with inhalation of the foreign
body into the airway is a real danger.NON-TRAUMATIC CONDITIONS OF THE NOSE
Epistaxis
DIAGNOSIS
1 This is usually spontaneous in children, occurring from vessels in Little’s
area on the anterior part of the septum, possibly precipitated by rhinitis or
minor trauma such as pick ing.
2 The bleeding occurs posterior to Little’s area in adults and may be associated
with a bleeding diathesis, including anticoagulant or antiplatelet drugs.
3 Bleeding originates higher in the posterior part of the nose in the elderly
from arteriosclerotic vessels, and rapidly leads to haemorrhagic shock if
profuse.
4 Send blood for full blood count (FBC), clotting study and group and save
(G&S) in any patient with profuse bleeding. Establish an i.v. infusion with
normal saline 10 mL/kg, before the patient becomes hypotensive, and restore
the circulation.
(i) Call the senior ED doctor immediately in these cases.