Laceration Evaluation
Summary: <br> Lacerations are the single best opportunity to demonstrate your procedural skills during your clerkship!!!<br> <br> <br> <br> To Close or Not To Close?<br> <br> <br> <br> * Closing a wound with sutures, etc = Healing by “primary intention”* INCREASES risk of infection but DECREASES scar* Leaving a wound open = Healing by “secondary intention”* DECREASES risk of infection but INCREASES scar<br> <br> <br> <br> Step 1: History<br> <br> <br> <br> * Does patient have comorbidities that increase risk of infection/poor healing?* Diabetes* Renal Failure* Obesity* Smoking* Immunosuppression* How long since injury happened?* Any concern for foreign body? <br> <br> <br> <br> Step 2: Identify Tetanus Status<br> <br> <br> <br> * Has patient EVER been immunized against tetanus?* Has it been >5 years since last tetanus shot?<br> <br> <br> <br> Step 3: Tetanus Prophylaxis<br> <br> <br> <br> * Give tetanus booster (Tdap) if >5 years since last tetanus shot* Give tetanus immunoglobulin (IG) if patient has never had tetanus immunization<br> <br> <br> <br> Step 4: Give Specific, Objective Description of Laceration<br> <br> <br> <br> * EXACT length* Must use a ruler* Most important BILLING categories* 2.5 cm or less* 2.6 cm to 7.5 cm* 7.6 cm to 12.5 cm* Description* Shape* Linear* Stellate* Flap* Depth* Superficial* Muscle* Bone* Neurovascular exam* Sensation* Motor* Cap refill<br> <br> <br> <br> Step 5: Rule Out Foreign Body<br> <br> <br> <br> * Consider X-Ray* Not all foreign bodies will show up on x-ray* Especially organic material, clothing, etc* Consider bedside ultrasound* (You are not expected to know how to do this, only to consider this)<br> <br> <br> <br> Additional Reading<br> <br> <br> <br> * Laceration Repair <a href="http://www.emclerkship.com/laceration-repair/">(EM Clerkship)</a>* Wound Closure for the Emergency Practitioner <a href="https://lacerationrepair.com">(LacerationRepair)</a><br> <br> <br> <br> <br>
