A 7-year-old girl is brought in by her parents after she fell off the playground equipment. She is crying, holding her nose, and there is blood staining her clothes. On examination, there is swelling of the nose but no obvious deformity. What are the potential diagnoses, and what are the next steps?
Given the history of trauma and her symptoms, this could be a nasal fracture, although the lack of obvious deformity could suggest it's nondisplaced. Another possibility could be a simple nosebleed (epistaxis) caused by the fall. First, the bleeding should be controlled. If there is suspicion of a fracture, imaging studies like facial X-rays or a CT scan can be performed to confirm. After confirmation, conservative management, including pain control, ice application, and monitoring for any signs of complications, is usually sufficient for pediatric patients. However, if the child has difficulty breathing or there are signs of a septal hematoma, referral to an otolaryngologist should be made.