Nose emergency

Definition
Nose emergencies include nosebleeds, an object lodged in the nose, and a broken nose.

Considerations

A fractured nose is the most common facial fracture. It usually results from a blunt injury and is often associated with other facial fractures. The bruised appearance usually disappears after 2 weeks.

Nose injuries and neck injuries are often seen together because a blow that is forceful enough to injure the nose may be hard enough to injure the neck.

Serious nose injuries cause problems that require immediate professional attention. However, for minor nose injuries, the doctor may prefer to see the injured person after the swelling subsides.

Nosebleeds are very common. A nosebleed may be caused by trauma such as nose picking, forceful nose blowing, direct impact to the nose, and other actions. A nosebleed may also be caused by irritation or dryness of the lining of the nose, which may occur with low humidity and dry environment, allergic rhinitis, colds, or Sinusitis. Deviated septum, foreign objects in the nose, or other nasal obstruction may also cause nosebleeds.

Most nosebleeds occur on the tip of the nasal septum, which contains many fragile, easily damaged blood vessels. Occasionally, nosebleeds may occur higher on the septum or deeper in the nose. These higher or deeper nosebleeds may be harder to control.

Occasionally, nosebleeds may indicate other conditions such as bleeding disorders, use of aspirin or blood thinners, hypertension, or arteriosclerosis. Hereditary hemorrhagic telangiectasia (also called HHT or Osler-Weber-Rendu syndrome), a disorder involving a blood vessel growth similar to a birthmark in the back of the nose, may become evident through nosebleeds.

Causes

     
  • Allergies  
  • Forcefully or frequently blowing the nose  
  • Drug abuse  
  • Dry air  
  • High blood pressure  
  • Large doses of aspirin  
  • Overuse of nasal sprays  
  • Picking the nose frequently  
  • Strenuous exercise  
  • Trauma to the nose  
  • Tumor  
  • Very cold air

Symptoms
Symptoms of nosebleeds:

     
  • Blood coming from one or both nostrils  
  • Bleeding into the back of the throat  
  • Frequent swallowing (because of bleeding into the back of the throat)  
  • Coughing up blood  
  • Gagging  
  • Sensation of fullness in the ears

Symptoms of an object lodged in the nose:

     
  • Difficulty breathing through the affected nostril  
  • Irritation  
  • Sensation of something in the nostril

Symptoms of a broken nose:

     
  • Pain  
  • Blood coming from the nose  
  • Bruising around the eyes  
  • Misshapen appearance of nose  
  • Signs of trauma  
  • Swelling

First Aid

FOR AN OBJECT LODGED IN THE NOSE:

  1. Do not probe the nose with cotton swabs or other tools. Doing so may push the object farther into the nose.
  2. Have the injured person breathe through the mouth and avoid breathing in sharply, which may force the object in further.
  3. Once it is determined which nostril is affected, gently press the other nostril closed and have the victim blow through the affected nostril.
  4. Avoid blowing the nose too hard or repeatedly.
  5. If this method fails, get medical help.

FOR A BROKEN NOSE:

  1. Reassure and try to calm the injured person.
  2. Have the injured person breathe through the mouth and lean forward in a sitting position in order to keep blood from going down the back of the throat.
  3. Apply cold compresses to the nose to reduce swelling. If possible, the injured person should hold the compress so that excessive pressure is not applied.
  4. To help relieve pain, acetaminophen is recommended.

FOR NOSEBLEEDS:

  1. Reassure and calm the injured person. Have the injured person breathe through the mouth.
  2. Have the injured person sit or stand upright and lean forward slightly to prevent blood going down the back of the throat. This will slow the flow of blood in the veins of the nose.
  3. Have the injured person pinch the nose with the thumb and index finger while breathing through the mouth. Do this for 5 or 10 minutes. This should stop the flow of blood.
  4. If the injured person’s nose is still bleeding after 15 minutes, try pinching the nose again for another 10 minutes. If the nose is still bleeding after the second try, get medical help.

Do Not

     
  • DO NOT try to remove an object that is not visible and easy to grasp - doing so may push the object farther in or damage tissue.  
  • DO NOT try to straighten a broken nose.  
  • DO NOT use tweezers or other instruments to remove an object lodged deeply in the nose.

Call immediately for emergency medical assistance if

     
  • You cannot easily remove a foreign object from the injured person’s nose.  
  • You suspect a neck injury or serious Head injury.  
  • You have a nosebleed that does not respond to first aid measures.

Prevention
To prevent a recurrence of nosebleed:

     
  • Use a lubricant such as Vaseline in the nose at night to help keep the inside of the nose moist.  
  • Avoid blowing the nose for 24 hours.  
  • Avoid hot beverages, alcohol use, Smoking, and aspirin for at least 1 week.  
  • Avoid physical exertion for a day.  
  • Breathe through the mouth as much as possible.  
  • Elevate the head with pillows when lying down.  
  • Sneeze with the mouth open.  
  • Try not to touch the nose at all for 24 hours.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.