A patient has rhinorrhea after head injury. What action should you take?

• A. A loose collection pad may be placed under the nose.
• B. Pack the nares with sterile gauze.
• C. Suction the drainage with an inline suction catheter.
• D. Obtain a sample for culture.

Answer: (A)

Rhinorrhea after head injury may be a cerebrospinal fluid leak from a skull-base fracture. The priority is to keep drainage unblocked and uncontaminated while you assess. Placing a loose collection pad under the nose allows drainage to be collected and monitored without inserting anything into the nasal passages or applying pressure that could worsen a leak. This also helps you determine if the drainage is CSF and provides a specimen for the medical team to evaluate. Packing the nares with gauze is avoided because it can obstruct drainage, increase pressure, and raise infection risk. Suctioning the drainage with an inline catheter is not appropriate here, as it can introduce pathogens into the CSF space and harm tissues. Obtaining a culture from the nasal drainage isn’t the immediate action; the goal is to identify a CSF leak and involve imaging and the medical team for further management.