Laceration Evaluation

Lacerations are the single best opportunity to demonstrate your procedural skills during your clerkship!!!











To Close or Not To Close?











* 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











Step 1: History











* 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?











Step 2: Identify Tetanus Status











* Has patient EVER been immunized against tetanus?* Has it been >5 years since last tetanus shot?











Step 3: Tetanus Prophylaxis











* Give tetanus booster (Tdap) if >5 years since last tetanus shot* Give tetanus immunoglobulin (IG) if patient has never had tetanus immunization











Step 4: Give Specific, Objective Description of Laceration











* 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











Step 5: Rule Out Foreign Body











* 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)











Additional Reading











* Laceration Repair (EM Clerkship)* Wound Closure for the Emergency Practitioner (LacerationRepair)