Another Saturday Night Facial Injury: Am I Managing These Patients Correctly?

Author: Jonathan D Whittaker / Editor: Jonathan D Whittaker / Reviewer: Peter Kilgour, Amanda King / Codes: O9 / Published: 17/12/2022

It is Saturday night and your next patient is a 28-year-old man who has been assaulted earlier that evening. He is accompanied by his friend who witnessed the assault.

The patient has been drinking but, for a change, he is co-operative and allows you to take a proper history and examination. He recalls being punched once in the left side of his face by an unknown assailant in a bar. He and his friend are clear that he was not knocked out and he remembers coming to the Emergency Department (ED) by taxi. He had a short nosebleed after the assault but this stopped spontaneously after 5 minutes and he has not had any further bleeding or discharge from the nose.

The patient states that he has not vomited and has no other injuries. He tells you that he is normally fit and well, doesn’t take any medication and has no allergies.

On examination, a routine set of observations show:

  • Pulse 76 / minute regular
  • BP 124/76
  • Respiratory rate 14 / minute
  • Oxygen saturation 97% on air
  • GCS 15
  • PERL
  • Temperature 36.8oC

You start your examination by making sure he has no other injuries, in particular to his chest, neck and skull vault. You move on to examine his face. You quickly ascertain that there is localised tenderness and swelling to the nose and left zygomaticomaxillary complex (ZMC) but the zygomatic arch is not tender and there is no palpable deformity.

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