Recently, I discussed off-grid strategies for nosebleeds, both minor and major. Bleeding often is spontaneous, but can also be related to trauma. Trauma to the nose can result, not only in bleeding, but also in damage to the bone or cartilage. Indeed, A fractured nose is the most common fracture of the face.
If there is a nasal fracture (“broken nose”), the patient will experience significant swelling and pain; any pressure on the nose may be seriously uncomfortable. Bleeding occurs in varying amounts, depending on the nature of the fracture. Blood collection in the nasal cavity can block breathing and can result in abscesses (collections of pus).
When examining the patient, you may notice a “crunching” sensation. Bruising beneath the eyes is common.
This injury can cause permanent deformity and difficulty breathing from a damaged septum (the wall that separates the nostrils). If there’s no major issue with breathing, however, it’s mostly a cosmetic problem. An instrument called a “nasal speculum” will allow you to inspect each nostril for blood clots or other abnormalities.
Early treatment for a broken nose places emphasis on decreasing pain, bleeding, and swelling. Apply cold packs over the nose for periods of 20 minutes on and off throughout the day. This will be useful only for the first 48 hours, but will help reduce swelling and discomfort. ‘
It should be noted that deformations caused by a nasal fracture will not straighten out by themselves, so the medic may sometimes choose to intervene in survival settings. If this is the course of action, it should be performed in three days or so, after swelling has subsided. This should not be attempted, however, after two weeks have passed (healing is too far along).
The goal of reducing the deformity is to realign cartilage and bone and to their original positions, to decrease discomfort, and maximize air flow. Be aware that this kind of manipulation may cause further damage and should not be done if modern medical care is available. Physicians use special instruments like nasal elevators and others to manipulate, pack, and “cast” the nose into its original shape. Most of these items are unlikely to be in your medical kit.
If modern medical care is not an option and you choose to intervene, the procedure goes as follows:
1) Sit the patient down. The pain associated with the procedure may cause lightheadedness.
2) Have them blow their nose once to eject blood and mucus.
3) Make a triangle with your hands, placing four finger pads of one hand against four finger pads of another.
4) Place the apex of the triangle snugly at the top of the nose.
5) Have the patient take a deep breath, then bring your palms together until they are molded firmly against the nose.
6) Slowly drag your hands straight down towards the chin.
If you were successful in reducing the deformity, you should then consider placing some moist gauze packing and taping the nose in position. The packing should not be removed for two or three days. Acetaminophen and Ibuprofen will be helpful for pain relief. Swelling in nasal passages may be improved with a nasal decongestant once the packing is removed.
A useful tool to splint the nose in position is the thermoplastic nasal splint. It can be placed on the nose with or without tape (Elasticon is an option) for stabilization. The splint helps reduce swelling and dead space during the healing process and protects against further injury.
How to use a Thermoplastic Nasal Splint for stabilization of the nose after treatment:
1. Activate the nasal splint by placing in water heated to 70-75 degrees Celsius (160 degrees Fahrenheit) for 3-5 minutes.
2. After it’s activated, the splint becomes soft and pliable, remove from water and dry it with a soft cloth.
3. Remove the glue layer, place it on the nose, pushing gently into position.
4. Within 3 minutes, it should become rigid and fixed.
1. Don’t put the nasal splint into water more than 175 degrees Fahrenheit (80 degrees Celsius).
2. Don’t allow the nasal splint to remain in water more than 10 minutes.
3. Store at room temperature.
It should be noted that a traumatic event hard enough to fracture the nose also can cause injury to the neck. Careful attention should be given to possible cervical spine damage; stabilization with a neck collar may be appropriate.
Joe Alton MD
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