Emergency Department Clinical Pathway for
Evaluation/Treatment of Children with a Laceration
Related Pathways
Triage
- Remind patient NPO until Team Assessment
- Analgesia, Wound care
Consider Subspecialist Consultation and Repair Consider analgesia, irrigation, dressing for comfort while awaiting subspecialist |
|
---|---|
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 facture 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 edged | |
OR repair likely given extent of wound or prolonged sedation need |
- Considerations for all Lacerations
- Special Wound Considerations
- Penetrating and/or puncture wound
- Animal bite
- Human bite
- Retained foreign body
- Delayed presentation
- Previously repaired wound with complications
FLOC/RN Team Rapid Assessment, H&P
- Neurovascular Assessment, NPO, Assess Pain
- Imaging Considerations
- Apply LET
- Consider Child Life Consult
Analgesia, Local Anesthesia, Anxiolysis & Sedation
- 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 minutes 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.- Follow-up Recommendations
- Wound Care Education
Posted: February 2019
Reviewed: February 2021
Authors: S. Fesnak, MD; E. Friedlander, MD; E. Lichtman, RN
Reviewed: February 2021
Authors: S. Fesnak, MD; E. Friedlander, MD; E. Lichtman, RN
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