Pediatric emergency medicine trisk 3264 3264

Management
Lacerations should be thoroughly irrigated and the wound closed primarily in a
layered fashion. If the injury involves cartilage, then these edges must be
approximated and closed prior to repairing the cutaneous layers. Hematomas
should be drained and a pressure dressing applied to prevent accumulation.
Prompt drainage reduces the risk of permanent external ear deformity often
referred to as “cauliflower ear.” In these cases, the wide incision should be made
along or within the cartilaginous folds of the auricle to fully evacuate clot or fluid
and to maximize cosmesis. Some practitioners prefer to place a compression
dressing utilizing dental rolls or petroleum gauze, while others prefer to place
“quilting” sutures through-and-through the auricle with nonabsorbable suture.
There is demonstrated safety and effectiveness for surgical management.
Patients with traumatic ear injury who are discharged home should be
encouraged to keep ear dressings in place to avoid infection, bleeding, or
reaccumulation of hematomas. The ears should be protected from further injury
and exposure until fully healed. They should be seen in 5 to 7 days by an
appropriate medical provider to remove dressings and sutures. For patients with
auricular hematoma, assessment for any reaccumulation is also important.
Although data are limited, patients who have auricular hematomas drained may
have a tenuous blood supply and, therefore, should receive a short course
(commonly 7 to 10 days) of prophylactic antibiotics. Quinolones are often
utilized as they cover routine skin flora (e.g., staphylococcus) as well as
Pseudomonas aeruginosa , and have effective penetration into cartilage.
Although there are reported risks of arthropathy with quinolones, no clinical
studies have demonstrated these findings in children. Therefore, quinolones are
felt to be the best choice in young children as well. Amoxicillin with clavulanate
is commonly recommended when there is hesitancy to use quinolones. Even with
empiric antibiotics, close monitoring for signs of chondritis including fever,
erythema, or purulent drainage is important, which should prompt admission for
intravenous antibiotic therapy.
Ears with cold thermal injury should be rapidly rewarmed and recooling should

be avoided. Hot thermal injuries should receive symptomatic care, avoiding
excessive cooling or ice in direct contact of the ear skin.

MIDDLE EAR
Current Evidence