On-site management of nasal injuries.

The on-site sports medicine physician must determine when nasal injuries can be treated at the site and when they must be referred. Conditions indicating referral include high-speed impact, loss of consciousness, associated facial injuries, and septal hematoma. Knowing the mechanism of injury is important; for example, inferior blows are likely to cause septal fracture, whereas lateral blows frequently result in displaced nasal bones. The physical exam includes careful inspection and palpation of surrounding structures as well as an intranasal exam. When the history and exam are benign, ice, elevation, topical decongestants, and a second exam in 1 to 2 days are the treatment of choice. Epistaxis must also be controlled.