Skin lacerations are a common cause of trips to the Emergency Department in the U.S., accounting for 8.2% of visits, which represents 7 to 9 million lacerations treated.(1) It can be difficult to tell whether a cut needs a doctor’s attention, according to a leading health clinic.(2)
Here are some signs that a wound requires an evaluation in the emergency department:
- Deep enough to expose the dermis or yellow subcutaneous fatty tissue
- Gaping open so you can’t easily use gentle pressure to press the edges together
- Located on or across a joint
- The result of an animal or human bite (A tetanus booster shot or oral antibiotics may be needed)
- A result of a foreign object impaling the area
- Made by a high-pressure impact from a projectile, like a bullet
- Contaminated or resulting from a dirty to rusty object
- Bleeding profusely
- On a cosmetically significant area, such as the face
- On or near the genitalia(2)
Before the patient gets to the emergency department, basic first aid is key. Pressure should be applied with a clean cloth, and the injured area should be elevated. (If blood soaks through the cloth, add another cloth, do not lift the original cloth.) Once bleeding stops, wash hands and gently wash the area with soap and water, and then cover the wound with gauze or a bandage.(3)
“Children are particularly susceptible to experiencing high levels of pain and anxiety during routine emergency procedures such as laceration repair.”(4) Injectable anesthetics are often used before suturing and are effective in reducing pain. Topical anesthetics may be used in children who have a needle phobia or have a contraindication to injectable anesthesia. Topical anesthetics may also be used before the injection of an anesthetic. Topical anesthetics have been shown to improve patient outcomes from procedures such as IV placement and lumbar puncture. They also reduce the need for injected anesthetic.(4)
A recent study compared the use of lidocaine-epinephrine-tetracaine (LET) gel with EMLA plus mepivacaine infiltration. The subjects were 59 children between the ages of 3 and 16 who presented at two medical centers. LET gel was administered to 37 children, 22 received EMLA plus mepivacaine. “Pretreatment was significantly less painful in LET versus the local anesthetics group,” the study reported. Both groups showed similar efficacy in terms of procedure time, need for secondary infiltration, and infection rate. Pain was measured using the faces pain rating scale (visual analogue scale).(5)
The study concluded: “It appears that LET is superior to conventional anesthesia including mepivacaine infiltration in the pediatric emergency departments. Pretreatment with LET is significantly less painful but equally effective. Hence, we recommend LET as a topical anesthetic in the pediatric emergency department.”(5)
For qualified providers, Edge Pharma offers LET gel in a convenient, single use 3mL syringe. Easy ordering, fast shipping, excellent customer service. Visit LET gel page to set up an account to order.
Reference
(1) Otterness, K., Singer, A., Clinical and Experimental Emergency Medicine, Updates in Emergency Department Laceration Management, https://www.ncbi.nlm.nih.gov/pmc/articles/.
(2) Cleveland Clinic, Does Your Cut Need Stitches? Find Out How to Tell, https://health.clevelandclinic.org/
(3) Santos-Longhurst, A., Whitworth, G. RN (reviewer) Do I Need Stitches? How to Tell if You Need Medical Care, https://www.healthline.com/
(4) Lambert, C., Goldman, R. M.D., Canada Family Physician, Pain Management for Children Needing Laceration Repair, https://pubmed.ncbi.nlm.nih.gov/
(5) Konigs, I., Wenskus, J. et. al., European Journal of Pediatric Surgery, Lidocaine-Epinephrine-Tetracaine Gel is More Efficient than Eutectic Mixture of Local Anesthetics and Mepivacaine Injection for Pain Control during Skin Repair in Children: A Prospective, Propensity Score Matched Two-Center Study, https://pubmed.ncbi.nlm.nih.gov/
