A 25-year-old man presents to the emergency department after sustaining a blunt injury to his face during a physical altercation. He has a laceration over his left eyebrow, and there is a palpable deformity of the nasal bridge. On examination, you note a nasal bone fracture with a deviation of the nasal septum. What is the most appropriate initial step in the management of this patient's nasal injury? A. Perform immediate surgical repair of the eyebrow laceration B. Order a CT scan of the head to assess for intracranial injuries C. Administer intranasal corticosteroids to reduce swelling D. Attempt closed reduction of the nasal fracture E. E. Refer to a maxillofacial surgeon for definitive management Answer: D. Attempt closed reduction of the nasal fracture Explanation: In a patient with a nasal bone fracture and a deviated nasal septum, the most appropriate initial step is to attempt the closed reduction of the nasal fracture. This can often be done in the emergency department by applying digital pressure to realign the fractured bones. Immediate surgical repair of the eyebrow laceration is a separate concern and can be performed after addressing the nasal fracture. A CT scan of the head is indicated if there are signs of severe trauma or neurological symptoms, but it is not the initial step for the nasal injury. Intranasal corticosteroids may be used to reduce swelling but are not the primary treatment for a deviated septum. Referring to a maxillofacial surgeon may be necessary for definitive management, but closed reduction is the initial step to attempt correction of the nasal fracture.
