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Triage Considerations
Children with minor trauma should be assessed for associated significant injuries.
Injuries that compromise airway, breathing, or circulation (systemically or locally,
such as in a limb) require immediate attention.
Wound management should not preempt care of more life-threatening injuries.
If there are no significant injuries, the focus should move to addressing
hemostasis and pain control. Application of topical anesthetics and administration
of oral analgesics can be initiated at triage. Once these measures have been
initiated, the emergency provider should aim for appropriate and timely wound
repair.
Clinical Assessment
History. In the evaluation of a laceration, it is important to understand the
mechanism of the injury because this has a direct impact on management plans.
For instance, if the wound was caused by an animal bite, the likelihood of
infection and devitalized tissue is higher, thus wound closure may be avoided and
healing by secondary intention may be preferred in selected areas (Chapter 94
Infectious Disease Emergencies ). Similarly, a wound caused by a blunt object
may be associated with an underlying fracture or crush injury. These injuries are
inherently more complicated and may require surgical consultation and hospital
admission. A wound caused by a sharp or projectile object may cause deeper
tissue or vascular injury. It is also important to determine the age of the wound, as
well as the possibility of a foreign body in the wound, since these factors also
need to be considered in the management of the wound.