Common Nose Emergencies - Their Management.

• Foreign Body in the Nose? Outline your management.

History/examination

Plain X ray of the nose in lateral and anteroposterior view (when necessary)

Removal of the foreign body (depending on the type):

*Flattened FB (eg piece of paper) -----> Removal by pair of Crocodile forceps

*Ireggular rounded FB ------>Removal by a rounded Hook or Probe (do NOT attempt by Crocodile forceps as it may cause the fb to be lodged deeper in the nose).

Treating Epistaxis?

Pinching ---->if unresponsive-----> Anterioir Nasal Packing ---->if unresponsive--- >Posterior Nasal Packing ----->if unresponsive-----> Cautery by Silver Nitrate.

*the patients presenting with severe epistaxis must be immediately made hemodynamically stable by:

maintaining ABGs, Vitals, Topical Decongestants and Normal Saline.

Sedation of the patient is necessary in most cases.

Blood should be arranged for trasnfusion.

If a patient is a known case of HTN, it must be controlled immediately to prevent further blood loss and plasma expanders to be infused.

*patients with posterior nasal packing are usually admitted in the ICU because the PNP may cause oxygen desaturation.

• Simplest method for Posterior Nasal Packing?

14 FR Foley's Catheter

• Management of Complicated Sinusitis (usually involving the eye and sometimes, the brain also)?

(In order of importance):

1. History/Examination


2. Call for assistance from Opthalmology/Neurology


3. IV antibiotics infusion (Ceftriaxone works best)


4. Observe for 24 hours, if sympotoms persist then proceed with surgery (Functional Endoscopic Sinus Surgery or External Ethmoidectomy) after a CT scan.

• Trauma leading to fracture of the nose, outline the treatment?

History/Examination

X- ray (it has great medicolegal importance)

Analgesics.

Reduction of the fracture ---> ONLY if the patient is brought in within 2 hours of the trama.

*If, however, the patients comes to you 2 hours after the trauma and edema is present then do NOT reduce the fracture then. Give analgesics and send the patient home, call after 7 days (aftet the edema has settled) to reduce the fracture.

• Treatment of Septal Hematoma?

Make an incision on one side

Drain the blood

Leave a small drain (to prevent re accumulation)

Pack the nose on both sides (remove after 48 hours)

Start prophylactic Systemic Antobiotics.

• Management of post Septoplasty (or any other nasal surgery) Septal Hematoma?

Re-open the already present surgical incision.

Drainage ----> leave the drain in for 1 day ----> Pack the nose

Give an Anti biotic cover.

• Treating Septal Abscess?

Incision on the most dependent part of the abcess

Evacuate the pus

(any necrosed cartilage will also be removed)

Place a small drain

Do nasal cavity packing

Send the pus was C/S and till the report comes in keep the patient on broad spectrum antibiotics.

*nasal pack should be removed daily and any pus accumulated should be drained for a few days till the condition subsides.

-Sources: Udairpuwala, Dr. K.I - HOD ENT department ZMUH KDLB, Dr. K.M - Professor of ENT department ZMUH KDLB.