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Injuries to the nose are not uncommon; yet, when they happen, people tend to panic. Instead of letting the situations “lead you by the nose”, follow these simple first-aid measures, and stay in control:
Your nose is not merely an organ of smell. It’s a filter, a temperature controller, a passageway and sometimes even an alarm system. It is closely connected with your eyes, mouth, ears and head, both cosmetically and physically. So, when it is injured, to treat it you’ve got to look beyond your nose.
“In order to treat any injury to the nose, you must first understand the nature and extent of the injury,” say ENT surgeons. “Basically, there are three kinds of injuries: those that involve the nose and the head; those that affect the nose and the face; those that pertain only to the nose. Only after the kind of injury has been ascertained can proper treatment or first aid follow.”
The first two kinds of injuries are usually the result of a violent, perilous impact, like a fall from a great height, or a road accident. When the nose and the head are injured – and such cases are obvious even to a layman – the damage is serious and can occasionally be fatal. In all probability, the victim will be unconscious and to render first aid would be impossible. Your only course of action is to rush the victim to a hospital and leave him in the hands of the doctors.
If the head is not hurt, that is, if the injury is only to the front of the face, then check the extent of the damage. Any injury to the eye directly, or even to the area around the eye, will need a doctor’s attention. You can try to control the bleeding of the nose if there is any, but the person should be taken quickly to the hospital. Probably he will need the attention of the ENT surgeon and the ophthalmologist.
Injury to the nose and to the area around it, that is, the sides and below, could mean damage to the sinuses and upper jaw. Ask the victim to make as if he is biting on something. Difficulty and pain in moving his mouth indicate probable fracture of the upper jaw. In this case, too, though you could try to control the bleeding from the nose, the victim needs medical attention. An ENT surgeon and a dental surgeon may have to work together to repair the damage. Therefore, such a case should be quickly taken to the hospital.
The third type of injury is more commonplace. In this kind of injury, first aid can be given, but again, it will depend upon the cause and nature of the injury. Injuries to the nose can be broadly grouped as external wounds; fractures; obstruction by foreign objects; bleeding from the nostrils.
External injuries like abrasions, bruises, cuts and punctures can be treated as you do wounds. Clean the affected area, apply an antiseptic and bandage. Slight abrasions or cuts will heal with adequate care. Deep and extensive wounds should be shown to a doctor.
Fractures of the nose are easily detectable from the distorted shape of the nose, the constant pain and swelling. Fractures have to be splinted and set right, which can only be done by an ENT specialist.
Those with children will b familiar with the third type of nasal injury – that is, blockage of the passage due to the insertion of foreign objects into the nose. “Often, the child may not be aware that he has done something he shouldn’t have, says ENT surgeon. “So the object remains in the nose for days and is discovered only when infection sets in. then, either the parents notice that the child’s nose is swelling, or the child complains of pain in the nose.”
However, even if you know that the child has pushed something up his nose, don’t try to extricate it yourself. You could push it in even further. Sometimes, lightly blowing the nose helps to dislodge the object. But if the object is edged, it may scrape or bruise the nose and bleeding may result. So it’s safest to take the child to a doctor, preferably an ENT specialist, as he is better equipped to deal with the problem.
Nosebleeds or epistaxis can occur due to a number of reasons: Sudden climatic changes; a rise in blood pressure; a traumatic injury; high fever.
The air we breathe in has to be homogenised to the body temperature of 34°C before it reaches the lungs. The nose acts as a temperature controller. If the air is cold, the nose warms it; if the air is too warm, the nose cools it. In order to help it carry out its function, the nose is heavily lined with blood vessels. The supply of blood depends upon the difference in the body and atmospheric temperatures. When the temperature outside changes suddenly, as when we move from a warm climate to a cold place, or vice versa, the demands on the blood vessels can be extensive and, consequently, they are likely to rupture, resulting in a nosebleed.
A rise in blood pressure forces the blood vessels to enlarge and sometimes even burst. Since the capillaries in the nose are fine, they rupture more easily. Thus a nosebleed could be a symptom of hypertension. Also, during plane flights, if cabin depressurisation takes place, the difference in air pressure outside the body and within affects the blood vessels and some passengers could experience bleeding from the nose.
Any trauma inflicted on the nose – say, when you fall while running and hit your nose on the ground, or when a child is hit on the nose by a ball while playing – ruptures the blood vessels inside the nose. Often, in these cases, the bleeding may seem heavy, but if there is no fracture, it may not be grave. However, once you’ve stopped the bleeding, you should get the patient checked by the doctor.
Sometimes the trauma can be light, as when a person digs in too hard to clean the nostrils. In that case, the bleeding stops spontaneously after a few minutes.
A high fever may sometimes be accompanied by a nosebleed. Again, this is because of the nose having to adapt to the difference in temperatures of the body and the air outside. ENT surgeon says, “This is occasionally seen in typhoid cases where the temperature rises very high.”
When bleeding from the nose occurs, you should first prop up the patient. Don’t let him lie flat. If you do that, the blood will rush back and enter the throat making him choke or cough, thus increasing the pressure on his blood vessels and forcing out more blood. “Sometimes the blood that is thus forced back goes into the stomach and the patient then vomits it out through the mouth,” says ENT surgeon. “At such times, everyone panics because the patient has vomited blood. They don’t realise he’s merely throwing out what he has swallowed.”
Ideally, the patient should be made to sit up; head bent over a bowl so that the blood can drip down from the nose. Pinch closed the nostrils, letting the patient breathe through his mouth. Often, this stops the bleeding. Or you could put an ice pack on the nose. To make the pack, put some crushed ice in a clean kerchief or cloth and pack it closely over the nose. Use crushed ice, not chunks, because it can be moulded around the nose, and even pressure applied. If ice is not at hand, give the patient a freshly-cut onion, or crushed garlic pods, or ammonium bicarbonate, to smell. The strong odour will repulse his sense of smell, forcing the nostrils to contract, and this stops the bleeding.
Nosebleeds are generally not serious. “In a normal person, the bleeding stops on its own after about five minutes,” says ENT surgeon. “That it lasts for a long time and that the flow is heavy are only impressions. What happens is that, in the absence of muscles in the nose, the tightly-packed blood vessels cannot contract. So the bleeding continues till clotting sets in. and that normally occurs in about five minutes. But if the bleeding does continue longer, don’t panic. Pinch the nostrils or use an ice pack to stanch the flow, which will happen after a while provided there is no serious damage. However, even if the bleeding stops you should get the injury examined by an ENT specialist to preclude complications later.”
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