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Last updated: 30 March, 2020 15:59pm

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Nasal Trauma – Information for GPs

Referral Criteria/Commissioning position

Referral to secondary care if:

  • there is a functionally impairing nasal septum deviation
  • the patient requires review for possible manipulation of a nasal deformity under local anaesthetic and is still within 10 days of the injury, speak to the on-call SHO directly

Red flag symptoms

  • history suggestive of or any clinical evidence of potential significant head or facial injury
  • palpable step in either orbital rim +/- suspicious facial haematoma
  • surgical emphysema in facial soft tissue
  • clear watery fluid leak from nose (?csf)
  • potential for penetrating injuries with or without foreign bodies
  • septal haematoma (untreated, this can lead to necrosis of the cartilage and collapse of the nasal bridge)
  • broken nose in a young child – the nose is still mostly cartilage and would require considerable force to break, consider possible inflicted injury

Investigations prior to referral (do not delay 2 week referral for these)

Usually none

Information to include in referral letter

The GP referral letter should contain:

  • Mechanism of trauma(s), timeline, previous injuries or operations
  • Possible details or reasons for presentation in General Practice rather than elsewhere
  • Expectations and understanding of the patient what a specialist may or may not be able to offer
  • Drug history (prescribed and non-prescribed) and allergies
  • Relevant past medical/surgical history
  • Current regular medication
  • BMI
  • Smoking status

Patient leaflets

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