Question 1

An alert, irritable 12-month-old child is brought to the emergency department by a parent who reports that the child fell into a coffee table. The child has epistaxis, periorbital ecchymosis, and nasal edema. Nares are patent, and the examiner palpates instability and point tenderness of the nasal septum. The orbital structures appear intact. What is an urgent action for this patient?

A) Assessment of tetanus vaccination
B) Ice, head elevation, and analgesia
C) Immediate nasal reduction surgery
D) Involvement of social services

D

Accepted Answer

The presentation of the child's injuries, particularly the mechanism of injury and the nature of the injuries (epistaxis, periorbital ecchymosis, nasal edema, and instability of the nasal septum), raises suspicion for non-accidental trauma (child abuse). Therefore, involving social services is an urgent action to ensure the child's safety.

Question 2

A provider performs a nasal speculum examination on a patient who sustained nasal trauma in a motor vehicle accident. The provider notes marked swelling of the nose, instability and crepitus of the nasal septum with no other facial bony abnormalities and observes a rounded bluish mass against the nasal septum. Which action is necessary initially?

A) Computerized tomography (CT) scan of facial structures
B) Ice packs to reduce facial swelling
C) Surgery to reduce the nasal fracture
D) Urgent drainage of the mass

D

Accepted Answer

The rounded bluish mass against the nasal septum is likely a septal hematoma, which requires urgent drainage to prevent complications such as infection or necrosis of the nasal cartilage.

Question 3

A child is hit with a baseball bat during a game and sustains an injury to the nose, along with a transient loss of consciousness. A health care provider at the game notes bleeding from the child's nose and displacement of the septum. What is the most important intervention initially?

A) Applying ice to the injured site to prevent airway occlusion
B) Immobilizing the child's head and neck and call 911
C) Placing nasal packing in both nares to stop the bleeding
D) Turning the child's head to the side to prevent aspiration of blood

B

Accepted Answer

The most important intervention initially is to immobilize the child's head and neck and call 911. The transient loss of consciousness indicates that the child may have sustained a concussion or more severe head injury that needs to be evaluated by a medical professional immediately. Immobilizing the head and neck will also help to prevent further injury or potential spinal cord damage. The healthcare provider at the game should not attempt to treat the injury on their own and should seek immediate medical attention for the injured child.

Deck 72: Nasal Trauma