MDM - Nasal Fracture

[##]-year-old [male/female] with history and exam consistent with nasal fracture.

Initial considerations in this patient included nasal bone fracture and displacement, septal hematoma, anterior and posterior vessels as a source of epistaxis, and other associated facial bone fracture among others.

Patient presented with report of [describe trauma] with evidence of swelling and deformity consistent with nasal bone fracture.  No evidence of septal hematoma on [speculum] examination of the nares.  Epistaxis well controlled with direct pressure [prior to presentation to/in] the ED.  Reduction in the ED considered, [and performed with appropriate splinting placed due to reasons] but deferred due to significant associated swelling and absence of significant breathing difficulty secondary to nasal swelling.  [No evidence of significant pain or deformity noted/Pain and swelling noted] on palpation of the facial bones with imaging [obtained and notable for findings/felt to not be indicated in the ED].  [No/Minimal] associated periorbital ecchymosis on exam.  No loss of extraocular muscle function, reported diplopia, or other findings suggestive of associated orbital wall fracture.  Doubt associated facial bone fractures at this time based on history and exam.

We discussed discharge with referral to ENT for follow up within 6-10 days for further evaluation and management.  We discussed avoiding blowing the nose to reduce further trauma.  We recommended application of ice to reduce swelling upon discharge.

Prior to discharge, we discussed return precautions, specifically for evidence of worsening pain or findings suggestive of septal hematoma, treatment [with NSAIDs/analgesics/Afrin], and follow up with primary care doctor within 1 week for further evaluation and follow up on ENT referral, and the patient demonstrated understanding and agreement with this plan.