Pediatric emergency medicine trisk 3297 3297

Current Evidence To target the use of CT among children with facial trauma, a few studies have identified clinical predictors of orbital fracture These studies have identified that orbital fractures requiring operative intervention are uncommon in the absence of orbital tenderness, swelling, ecchymosis, nausea/vomiting, or painful extraocular movements Studies suggest that early repair (within 24 to 48 hours) of orbital trapdoor fracture and release of the entrapped muscles may help avoid muscle ischemia and fibrosis, and result in better functional recovery A few studies have also demonstrated that corticosteroids may decrease swelling and hasten resolution of diplopia among patients with limitation of extraocular movement Nasal Fracture Goals of Treatment The primary goals in treatment of nasal fractures in the emergency setting are immediate recognition and drainage of septal hematoma, and in children, reduction of nasal fractures with deformity within days CLINICAL PEARLS AND PITFALLS Nasal fractures may be difficult to detect clinically because of significant swelling Septal hematomas require urgent incision and drainage to avoid necrosis of the avascular septal cartilage Patients with nasal deformity to days after injury require urgent consultation with a subspecialist to restore anatomic alignment Clinical Considerations The nasal bones are among the most commonly fractured bones of the facial skeleton because of their prominent location on the face Nasal fractures may be difficult to detect because of significant swelling associated with such injuries Imaging is rarely needed in the emergent care of children with nasal trauma because, in most cases, it does not contribute to subsequent care and management Most nasal injuries can be managed as an outpatient, and evaluation after the swelling subsides dictates the need for further intervention Two particular nasal injuries that deserve specific comment are the intractable nosebleed and septal hematomas Because of the rich vascular network in the