A resident of ill-repute was minding his own business on the way to his shift when he was assaulted. He complains of nose pain and that conference is too early in the morning. The attending was anxiously awaiting the arrival of said tardy resident, and then was immediately seen as above. What is is happening?

A. the correct approach to “feedback” for tardiness as per departmental policy

B. an attending of ill-repute minding her own business

C. bilateral carotid massage

D. an impending nasal fracture, which today’s pearl will be about

E. all of the above


A refresher on nasal fractures if your patient is not Steve Nash :


-nasal fractures comprise 40% of facial bone injuries
-clinical diagnosis, though obtain CT if suspect other injury
-look out for septal hematoma (immediately incise, drain), crepitus, limited eye movement/acuity or signs of trauma, CSF leak, other injuries to area
-can attempt reduction if seen soon after injury, fracture is not complicated, and without significant swelling (3-6 hrs). ( Life in the fastlane blog has a post with video )

diagram from aafp.org showing (A) diagram of hematoma (B) incision after anesthetic (C) drainage of hematoma (D) packing of guaze