What are the signs of a severe nasal injury to look for after a direct hit to the nose?

Signs to Look for After a Direct Hit to the Nose

After a direct hit to the nose, you should immediately check for signs of brain injury, obvious nasal deformity, or facial fractures, as these require immediate medical attention. 1

Immediate Assessment

Critical Signs Requiring Emergency Medical Attention

• Epistaxis (nosebleed) that:
  • Doesn't stop after 15 minutes of continuous pressure 1
  • Causes lightheadedness 1
• Signs of brain injury following nasal trauma 1
• Obvious nasal deformity 1
• Signs of facial fracture 1

Proper First Aid for Nosebleeds

• Have the person sit with their head slightly forward 1
• Pinch the lower third (soft portion) of the nose firmly for 10-15 minutes continuously 1
• Have them breathe through the mouth and spit out any blood 1

Secondary Assessment

Nasal Examination

• External deformity:
  • Deviation or asymmetry of the nasal bones 2
  • Saddle nose deformity (depression of the bridge) 2
• Septal hematoma - critical to identify as it requires urgent drainage 3
  • Look for bluish, bulging swelling of the nasal septum
  • Bilateral obstruction of nasal passages
• Crepitus (crackling sensation when touching the nose) - may indicate fracture 2
• Mobility of nasal bones - abnormal movement suggests fracture 2

Additional Warning Signs

• Clear fluid draining from the nose (possible cerebrospinal fluid leak suggesting dural tear) 2
• Periorbital ecchymosis ("raccoon eyes") - may indicate more serious fractures 2
• Enophthalmos, diplopia, or infraorbital nerve paresthesia - suggesting orbital involvement 2

Risk Factors Requiring Special Attention

• Anticoagulant or antiplatelet medication use - patients should seek professional care unless bleeding has completely stopped 1
• Blood clotting disorders - increases risk of prolonged bleeding 1
• High-velocity injuries - more likely to cause significant damage 2

Common Complications to Monitor For

• Persistent nasal deformity 2, 4
• Nasal airway obstruction 4
• Septal perforation 4
• Saddle nose deformity (from untreated septal hematoma) 4

When to Seek Medical Care

• Epistaxis not controlled after 15 minutes of pressure 1
• Signs of brain injury, facial fracture, or obvious nasal deformity 1
• Taking blood thinners or having clotting disorders 1
• Development of septal hematoma (requires urgent drainage) 3
• Clear fluid drainage from nose (possible CSF leak) 2

Remember that nasal trauma is the most common bone injury of the adult face 5, and while it may initially seem minor, it can lead to significant cosmetic or functional defects if not properly assessed and managed. The most critical immediate concern is to rule out septal hematoma, which requires urgent drainage to prevent cartilage necrosis and subsequent deformity 3, 4.