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Laceration — Frontline Ordering Clinician (FLOC)/RN Team Rapid Assessment, H&P — Clinical Pathway: Emergency

Laceration Clinical Pathway — Emergency Department

History and Physical

History and Rapid Assessment
  • Injury information
    • Mechanism
    • Location, time of injury
    • Associated symptoms
    • First aid, wound care
  • Pain medications
  • Last PO intake solids, liquids
  • Tetanus status
  • Pain, symptoms suggesting additional injury
  • PMH
    • Medications
    • Allergies
    • Medical co-morbidities
Physical Exam
  • General
    • VS, GCS, Pain Score
    • Evidence of other injuries, consider non-accidental trauma
    • Type and extent of laceration
  • Hemostasis
    • Confirm hemostasis
    • Consider surgical consult if concern for arterial bleed
  • Neurovascular exam
  • Joint capsule involvement or possible open fracture
    • Significant injury over knee, elbow, etc.
    • Consider orthopaedics exploration of joint capsule before repair

Radiology Imaging Considerations

  • Concern for associated fracture based on mechanism of injury
    • e.g., crush injury or significant tissue damage from a dog bite
  • Concern for foreign body

LET Application

Consider team assessment exam of the wound to promote LET application upon child's arrival to the room.

Indications Repair of lacerations of any size anywhere on the body
Includes areas adjacent to mucous membranes, nose, ears, digits and genitalia
Contraindications Known allergy to local anesthetics, severe heart block, methemoglobinemia

 

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