Pediatric emergency medicine trisk 3376 3376

Appropriate use of sedation and local anesthetics is essential for successful
repair of lacerations in some children. Some younger children can undergo repair
after being placed in a restraining device, such as a papoose board, or wrapping
the child securely but comfortably in a bedsheet for better immobilization.
Restraint is needed to ensure the child’s safety and allow for more rapid
completion of the procedure. Because the child may get excessively warm while
being restrained, it is important to ensure proper ventilation and assess the child’s
comfort during the restraint process. A caring, but firm assistant is often needed
to further immobilize the injured body part and complete the procedure
successfully. It is better to use such hospital personnel instead of parents to
immobilize a child. A school-age child can usually cooperate without restraint.
Some children may require procedural sedation and/or anesthesia depending on
the type, extent and location of the wound, and the child’s age and level of
development (see Chapter 129 Procedural Sedation ). Some extensive wounds
may warrant more significant repair that is best accomplished with surgical
consultation and possible intraoperative repair.
Minimizing Risk of Infection. Hair near the wound usually creates minimal
difficulty during repair. Shaving the hair in the area of the wound may damage
hair follicles and increase risk of infection. If necessary to facilitate repair, the
hair should be clipped with scissors. Alternatively, petroleum jelly can be used to
keep unwanted scalp hair away from the wound while suturing. Hair over the
eyebrows should never be removed because this may lead to abnormal or slow
regrowth.
It is essential to clean the wound periphery at the time of wound evaluation.
Povidone-iodine solution (a 10% standard solution) is often used because it is a
safe and effective antimicrobial with little tissue toxicity. This solution may be
diluted with saline 1:10 to create a 1% solution. Use of chlorhexidine or
povidone-iodine surgical scrub preparations, hydrogen peroxide, or alcohol in the
wound itself is not recommended. These may be irritating to tissues and may
injure white cells, increasing the risk of infection.
Wound irrigation is extremely important to reduce bacterial contamination,

remove any particular matter, and prevent subsequent infection. It is often
necessary to anesthetize the wound before thoroughly cleansing. Using universal
precautions, the wound should be irrigated with normal saline, approximately 100
mL/cm of laceration. More may be needed if the wound is unusually large or
contaminated. Use a large syringe (20 to 60 mL) with a splash guard (commonly
20-gauge bore) attached to the end to reduce splatter during the irrigation. With