Emergency Department Clinical Pathway for
Evaluation/Treatment of Children with a Laceration

  • 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
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

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