Emergency Department Clinical Pathway for
Evaluation/Treatment of Children with a Laceration

Consider Subspecialist Consultation and Repair
  • Consider analgesia, irrigation, dressing for comfort
    while awaiting subspecialist
  • If anticipated procedural time > 45 mins., review need for OR repair with consulting service
Plastics/OMFS Complex facial laceration
Facial nerve injury, extension to cartilage
Parental request
Ophthalmology Concern for extension through lid margin, ductal system, or globe injury
Orthopaedics Partial or full digit amputation
Tendon injury, nerve injury
Concern for open fracture or extension to joint space
Nail bed injuries
Trauma Multilayer closure
Vascular injury, inability to achieve hemostasis w/prolonged pressure
Significant debridement required
Significant tension on wound edges
OR repair likely given extent of wound or prolonged sedation need
  • Remind patient NPO until team assessment
  • Analgesia, Wound care
  • Apply LET
ED Team Assessment
  • Consider the following options to avoid sedation:
  • PO Analgesia: Ibuprofen
  • Anesthesia: LET, Lidocaine/local anesthesia
  • Anxiolysis: IN or PO midazolam
  • Distraction with Child Life
  • Aim: Wound repair 30 mins after LET application
Irrigation
  • Gently clean lacerations with normal saline or sterile water
  • Consider using bottle of solution with splash cap, the soft side of a surgical scrub brush, or gauze if there is gross contamination
Considerations for All Lacerations
  • Follow-up Recommendations
  • Wound Care Education
Posted: February 2019
Last Revised: October 2024
Editors: Clinical Pathways Team