ENT Conditions

Fractured nose  
These are of three types: 
- Undisplaced:  Discharge 
- Deformed:  Refer to ENT clinic for consideration of manipulation    
- Septal haematoma: Refer to ENT on call 
a) A patient (particularly if elderly) who is unfit for general anaesthesia or who has a displaced fracture, but who has a patent airway and who is happy with the shape of the nose can be discharged without follow up. 
b) Nose injuries in children under 10 years are unlikely to need manipulation, and it should be rare for them to need review. 
c) In general, X-rays are not indicated. A deformed nose needs treating whatever the X-ray shows, and a straight nose needs no treatment even if there is a fracture. 
Foreign bodies 
In children, always check for bilateral foreign bodies.  
If co-operative you may have ONE attempt to remove the foreign body with appropriate instruments. If you fail - refer to ENT or seek senior ED advice. DO NOT use a Yankauer sucker in the ear.  
If the child is NOT co-operative DO NOT try to remove as you may damage the tympanic membrane - refer to ENT. 
Small objects (e.g. insects) may be removed by gentle syringing if the tympanic membrane is intact. Live insects can be killed with Lignocaine 1% 
Most commonly seen in children. 
Ask the parent to blow forcefully into the child’s mouth while occluding the other nostril. 
IF the child is cooperative and you can easily visualise the object you may have one attempt to do so. IF you fail, seek senior advice or refer to ENT.  
If the child is uncooperative do not try to remove a FB. Seek senior advice or refer to ENT.