How should I manage a patient with a nasal fracture who presents with significant nasal bleeding?

Initial management of a patient with a nasal fracture presenting with significant nasal bleeding involves first ensuring airway patency and controlling the bleeding. Apply direct pressure to the nasal alae and have the patient sit upright with the head tilted slightly forward to reduce venous pressure and minimise blood swallowing or aspiration ¹. If bleeding persists, anterior nasal packing may be necessary to achieve haemostasis, using appropriate nasal packs or tampons ¹.

Assess for signs of more severe injury such as septal haematoma, which requires urgent drainage to prevent cartilage necrosis and deformity. If a septal haematoma is suspected, prompt ENT referral is essential ¹.

Once bleeding is controlled, a thorough clinical assessment should be performed to evaluate the extent of the fracture and any associated injuries. Imaging is not routinely required unless there is suspicion of complex facial fractures or complications ¹.

Recent literature emphasises the importance of early and effective bleeding control to prevent complications and suggests that nasal packing materials should be chosen to balance haemostatic efficacy with patient comfort and risk of infection (Marston et al., 2017). Additionally, sports-related nasal injuries highlight the need for protective measures post-injury to prevent rebleeding and further trauma (Marston et al., 2017).

After stabilisation, patients should be advised to avoid nose blowing, heavy lifting, and strenuous activity for several days to reduce the risk of rebleeding and to seek ENT follow-up for possible fracture reduction if indicated ¹.