Emergency Department Clinical Pathway for
Evaluation/Treatment of Children with a Laceration
Related Pathways
Consider Subspecialist Consultation and Repair
|
|
---|---|
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 |
ED Team Assessment
-
History and Physical
- NPO
- Assess Pain
- Neurovascular Assessment
- Special Wound Considerations
- Imaging Considerations
- If > 30 mins since last LET application, reapply
- 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
Evidence
- A Randomized, Controlled Trial Comparing Long-term Cosmetic Outcomes of Traumatic Pediatric Lacerations Repaired with Absorbable Plain Gut Versus Nonabsorbable Nylon Sutures
- Tissue Adhesives for Traumatic Lacerations in Children and Adults
- Topical Anaesthetics for Pain Control During Repair of Dermal Laceration
- Sutures, Needles, and Tissue Adhesives: a Review for Dermatologic Surgery
Media
- Basic Suture Techniques for Laceration Repair Video Series
- Primary Care Perspectives: Podcast for Pediatricians
Episode 68: Evaluating Lacerations in Primary Care