Emergency Medicine at HCMC
Lacerations – the laceration carts in
the ED have most/all of what you need
A. Anesthesia – Lidocaine
or Marcaine without epinephrine in fingers, nose, toes, and penis; Marcaine
lasts longer and if you feel the wound will take longer than an hour – use
Marcaine. Be sure to use anesthesia prior to irrigation. When injecting
the anesthetic use a 25 or 27 gauge needle. Lidocaine may be buffered
10:1 with Bicarb but not Marcaine. Inject within the laceration
for less painful anesthesia.
B. Irrigation – the key to preventing infection. Take the time
to irrigate well. There is currently a wound study with normal saline
vs. tap water – the instructions are on the laceration cart.
C. Type of suture to use and length of time to leave suture
1. face – 6.0 nylon / 5 days
2. head – staples or 0 nylon / 5-7 days
3. arms/legs – 3.0 or 4.0 nylon / 7-14 days
4. eyebrows – 5.0 or 6.0 nylon / 5 days ( do not shave eyebrows)
5. lips – everyone does these differently be sure to ask the
staff/senior
D. Exploration – once the wound is numbed and
irrigated explore the wound well with sterile gloves and look for foreign
bodies or fractures/step
offs
E. Check Neuro motor and sensation distal to injury prior to anesthesia.
F. Splinting – wounds over flexor surfaces or under lots of tension
often do better with splints for a few days.
G. Documentation – done on EMSTAT under "Physician" then "wound
care/lacerations"
H. Follow-up : patients need wound care sheet, wound check in 2 days
for concerning or contaminated wounds and suture removal in ? days.
Abscess / I & D:
A. Anesthesia should be
lidocaine or Marcaine without epinephrine.
B. Most patients need some pain medicine prior to procedure.
C. Incision & Drainage kits are in B6
D. If there are no I & D kits, take the individual instruments
you need from the laceration carts.
E. Follow-up : Wound check in 1-2 days and wound care sheet.
F. Antibiotics – given if there is a large cellulitic component
or fever. Need to cover staph and strep.
G. Be sure to document if packing was placed in the wound.
For more information contact Richard
O. Gray MD.
Emergency
Medicine main page
Copyright © 2000 HCMC Emergency Medicine. All rights reserved.
Manual last modified: Wednesday May 07, 2003.
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