darkhorse
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A 24-year-old woman underwent a laparoscopic appendectomy for acute appendicitis. She was given 3 doses of intravenous antibiotics and was to be discharged on the second postoperative day. On the morning of second postoperative day, while trying to get out of the bed, she slipped, fell, and bumped her nose on the bedside table. You are called to the floor to evaluate the patient because she is now complaining of some difficulty in breathing through her nose. On examination, the patient is afebrile, and is feeling well except for the nasal trauma. You notice a hyponasal noise during the conversation. Examination of the nose reveals a swollen nose with a bruised outside and a small laceration on the nasal ala. Examination of the nasal cavity reveals a swelling in the region of the nasal septum, which is more prominent to one side. Examination of this swelling by means of a nasal speculum, reveals that it is soft and fluctuant. The nasal trauma happened 1 hour ago. At the end of the examination, the patient says that apart from hyponasal voice and some amount of pain, she is not feeling any discomfort and is ready to go home. You advise this patient that
A. continued observation in the hospital is necessary
B. intravenous antibiotic therapy is indicated
C. oral antibiotic therapy for 1 week is necessary
D. she can be discharged home and can follow-up in the office in 2 weeks
E. surgical drainage of the swelling is indicated at this time
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| plastic_surgery
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E. drainage of swelling. it is septal hematoma and needs drainage otherwise leads to fibrosis and deviated nasal septum..
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| neurom
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expanding hematoma can compromise blood supply of the nasal cartilage-> avascular necrosis, accumulated blood -> predisposition to bacterial infection -
E
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| DRamarnath
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 wats the correct reason for E being choosed
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| bax
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e
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| anastamosis
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E.
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| drduck
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very nice Q,
expanding hematomas can compromise blood supply....and airway too.
but would like to keep him under observation...with tight compression bandage.
i dont know whether i m thinking too much.......damage to such area predispose to cavernous sinus thromosis.
but what is the relation between this event and appendix surgery.
plz post the answer.
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| guangyu
Forum Elite
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i think you can not drainage the swelling site only after one hour, you have to let the bleeding stop. so A is the right answer.
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| maoudoody
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those who chose E
wat about appendectomy...a semi septic operation?
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| robin082006
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I go with A
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| elixir
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Another job for DR HOUSE lol
nah,it's E
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| Miradautas Vras
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E Septal hematoma get infected very easily. drain now.
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| farnsworth
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E
1) hematomas get infected
2) destruction of nasal cartilage (diminished blood supply, cartilage is bradytrophic tissue, nurtured by diffusion. + infection)
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| simi
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darkhorse can u post the ans given plz
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| dr ruman
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septal hematoma treatment draniage followed by prophylactic antibiotic ,and reason same as decribed above(reference sports injury google search)
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| WaqasQureshi
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its SEPTAL HEMATOMA:
incision near the floor of nasal cavity, drain the blood and give antibiotics. Send home with light nasal packing.Send home.Follow up for removal of nasal packing in 2 days and apply paraffin daily. Report earlier if recurrence of bleeding.
answer is E
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| Jcala
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E
Septal hematomas require drainage, otherwise can produce perforated septum.
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| aspire
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E?
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| inkspot
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A:
the patient was given IV antibiotics earlier ---> dec vitamin K ------> minor trauma leading to septal hematoma ----> further workup ( coagulation profiles ) and observation is required in hospital first and ofcourse drainage should be done.
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| not much time
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i think D
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| grechita12
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A
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| smalley
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A
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| solitarius
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hypnasal voice+difficulty breathing=secure the airways in hospital setting...please correct me if I am wrong......BTW where is "arlete"?we need your input too........
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| paheli
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I'm going with A.
What's the answer, darkhorse? And, what's the source of the qn?
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| doc649
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eeeeeeee
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