What is the first aid for blunt trauma to the nose?

First Aid for Blunt Trauma to the Nose

For blunt trauma to the nose, immediately position the patient sitting upright with head slightly forward and apply firm sustained compression to the lower third of the nose for 5-15 minutes to control any bleeding. 1

Initial Assessment and Management

1. Position and Compression

   • Have the patient sit upright with head tilted slightly forward
   • Apply firm pressure to the lower third of the nose for 5-15 minutes
   • Instruct patient to breathe through the mouth and spit out any blood to prevent aspiration 1

2. Assess for Septal Hematoma (Critical Emergency)

   • Perform anterior rhinoscopy after removing blood clots
   • Look for bluish, fluctuant swelling of the nasal septum
   • If present, requires urgent drainage to prevent cartilage necrosis and subsequent deformity 1, 2

3. Control Epistaxis (Nosebleed)

   • If bleeding persists after compression:
     • Apply topical vasoconstrictors if available
     • Consider topical tranexamic acid which can control bleeding within 10 minutes in 71% of patients 1
     • For persistent bleeding, nasal packing may be necessary 1

Evaluation for Fracture

Evaluate for signs of nasal fracture:

• External deformity or asymmetry
• Crepitus or mobility of nasal bones
• Tenderness over nasal bones
• Periorbital ecchymosis ("raccoon eyes")

CT imaging is not routinely indicated for isolated nasal trauma but may be warranted if there is suspicion of:

• Orbital, maxillary, frontal, or zygomatic fractures
• Complex facial trauma 3, 4

When to Seek Emergency Care

Refer to emergency department if:

• Suspected septal hematoma
• Significant epistaxis not controlled with compression
• Signs of nasal fracture requiring reduction
• Significant facial deformity
• Bleeding lasting >30 minutes
• Signs of hypovolemia (tachycardia, hypotension) 1

Follow-up Care

• Apply cold compresses in the first 24-48 hours to reduce swelling
• Keep head elevated while sleeping
• Avoid activities that might cause additional trauma
• Avoid nose blowing for 24-48 hours
• Consider nasal moisturization with saline gel or spray to promote healing 1

Special Considerations

• For displaced nasal fractures, reduction should be performed within two weeks before the bones begin to unite 4, 5
• Even with proper treatment, cartilage injuries may heal with deviation, potentially requiring later reconstructive surgery 2
• Undisplaced nasal fractures without functional symptoms can be managed conservatively 4

Common Pitfalls to Avoid

• Failing to recognize and drain a septal hematoma, which can lead to septal perforation, saddle nose deformity, or infection with potential intracranial spread 2
• Overlooking associated facial fractures in cases of significant trauma 3
• Delaying referral for displaced nasal fractures beyond the 2-week window for optimal reduction 4, 5
• Inadequate patient education about signs of complications requiring urgent care 1