A 17yo boy comes in with complaint of inability to breathe from the right nares. He was seen 2 days ago by his PMD and prescribed amoxicillin for sinusitis, but is not improving. He denies placing any foreign body in his nose. He was in an altercation at school and was hit in the nose 4 days ago. Which of the following would be the most appropriate treatment of this patient’s condition?
http://rhinitis.hawkelibrary.com/album09/83_G
A. Change antibiotics to amoxicillin-clavulanate
B. Attempt removal of foreign body
C. Incision and drainage and nasal packing
D. Referral to otorhinolaryngologist for polyp removal
Also, if you’re interested in the Peds ID Antibiotics Question of the Week, you can find it here
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June 20, 2017 at 8:27 am
The answer is C. Incision and drainage and nasal packing. The patient has a nasal septum hematoma from the trauma sustained 4 days earlier. Unless drained, pressure necrosis of the septum can result in a saddle deformity. The hematoma should be drained urgently in the ED or by ENT in clinic if immediate referral is possible, and nasal packing is used to create a pressure dressing that prevents reaccumulation of the hematoma.