168 SECTION 3 • MEDICAL PROBLEMS IN THE ATHLETE
- Signs and symptoms:Acute pain, facial swelling,
and nasal obstruction. - Examination:A bluish bulge is seen on the nasal
septum. - Treatment:Prompt aspiration is the key to successful
treatment. Aspiration is done using an 18–20-gauge
needle; then packing the nose with bilateral nasal pack-
ing for 4–5 days to prevent recurrence. Prophylactic
antibiotics are used for 10–14 days to prevent abscess
formation (Norris and Peterson, 2001a).
EPISTAXIS
ANTERIOREPISTAXIS
- Ninety to ninety-five percent of all nosebleeds are
anterior. The most common site for bleeding is from
the Kiesselbach’s plexus in Little’s area on the ante-
rior septum. - Signs and symptoms:Dripping blood from the nostrils.
- Treatment:Ice and compression of the nose are the
mainstays of treatment. Cautery may be considered if
pressure fails and the bleeding site can be identified
(silver nitrate or electrocautery pen). Nasal packing
may also be used for compression if bleeding site
cannot be identified. Strenuous activity should be
restricted if nasal packing is required, until the pack-
ing can be removed. Return to play should not be
allowed with nasal packing in place as the potential
for airway obstruction exists. If no packing is required
and the bleeding is controlled with ice and compres-
sion, the athlete may return to play as soon as the
bleeding has ceased.
POSTERIOREPISTAXIS
•Five to ten percent of nosebleeds.
- Signs and symptoms:Bleeding that drains mainly
through the posterior pharynx. - Examination:The bleeding cannot be directly visual-
ized. Must evaluate for other facial trauma to include
orbital fracture and nasal fracture. - Treatment:Failure of bleeding to stop with com-
pression is a sign that it may be of posterior origin.
Most posterior bleeds require more than an on-the-
field assessment. These athletes should be evacuated
to a hospital for ear, nose, throat (ENT) consultation.
Emergent hemostasis can be achieved with a small
Foley catheter, inserted through the nare, inflated in
the posterior pharynx, then pulled snug against the
posterior nare, tamponading the bleeding and pro-
tecting the airway (Norris and Peterson, 2001a;
2001 b).
TRACHEAL INJURIES- Blunt trauma to the anterior neck can have devastating
effects on the larynx and the trachea, causing serious
airway compromise. Hockey (ice, field, roller), football,
softball, baseball, wrestling, soccer, lacrosse, and gym-
nastics are the sports more commonly associated with
tracheal/laryngeal injury. Hockey, baseball, softball,
lacrosse, and fencing all require the athlete to wear
neck protecting extensions or masks to protect the
anterior neck. Blunt trauma to this region can produce
both contusions and fractures of the larynx and the
trachea, causing laryngospasm.
LARYNGOSPASM- Laryngospasm is a spasmodic closure of the glottic
aperture. This occurs when the muscles of the vocal
cords contract and pull the cords together and the
upper surface of the cords overlap—causing obstruc-
tion of the airway. - Signs and symptoms:Bruising, shortness of breath,
hoarseness, loss of voice, pain, point tenderness,
cough, dysphagia, cyanosis, and loss of consciousness. - Examination: Ensure an open airway, palpate for
subcutaneous emphysema, and fracture of the thyroid
cartilage (Adam’s apple). Observe respiratory rate and
monitor for signs of respiratory compromise. - Treatment:Laryngospasm causes a sudden inability
to breathe; causing immediate anxiety and even panic
in the athlete. The athlete needs reassurance and
careful maintenance of the cervical spine in a neutral
position. The jaw thrust maneuver should be used to
pull the hyoid bone and the surrounding tissues away
from the larynx, thereby opening the airway. As the
spasm relaxes a loud inspiratory crowing sound is
heard. The spasm usually relaxes in less than 1 min. A
responsible adult should observe this individual for
the next 48 h, as future swelling may occur. Laryngeal
swelling usually maximizes in 6 h postinjury but may
occur as late a 48 h postinjury. This swelling of the
larynx can lead to airway obstruction and fatality if
not monitored for signs of respiratory compromise.
The athlete should not be allowed to return to play for
at least 48 h, to ensure the swelling has resolved
(Swinson and Lloyd, 2003; Blanda and Gallo, 2003;
Norris and Peterson, 2001a).
LARYNGEAL FRACTURE- Laryngeal and tracheal fractures are also caused by
blunt anterior neck trauma; however, the blow is usu-
ally much greater in force. The signs and symptoms