Emergency Management of Multiple Pediatric Wounds

Initial Irrigation & Wound Cleaning

Use copious running tap water or sterile saline for wound irrigation; both are equally effective and superior to antiseptic solutions such as povidone‑iodine. (American Heart Association) 1
Continue irrigation until all visible debris and foreign material are removed. (American Heart Association) 1
Avoid high‑pressure irrigation, which can drive bacteria deeper into tissue. (American Heart Association) 1

Do not use antiseptic solutions (povidone‑iodine, chlorhexidine) for wound irrigation; they provide no benefit over water/saline and may impair healing. (American Heart Association) 1

Provide early analgesia; topical lidocaine‑prilocaine preparations are effective for superficial wounds in children with intact sensation. (American Heart Association) 1

Give tetanus booster for clean, minor wounds only if >10 years have elapsed since the last dose. (CDC) 3
Give tetanus booster for contaminated, puncture, crush, or wounds >8 hours old if >5 years have elapsed since the last dose. (CDC) 3
If vaccination history is unknown or incomplete, administer the age‑appropriate tetanus vaccine immediately (DTaP < 7 y, Td 7‑10 y, Tdap ≥ 11 y). (CDC) 3
Administer tetanus immune globulin (250 U IM) for tetanus‑prone wounds when the primary series is uncertain or incomplete; give TIG and tetanus toxoid at separate injection sites. (CDC) 3
In mass‑casualty situations with limited TIG, prioritize patients >60 years and immigrants from regions outside North America/Europe. (CDC) 3

Prescribe prophylactic antibiotics for high‑risk wounds: hand injuries, puncture wounds, animal bites, human bites, wounds >8 hours old, heavily contaminated or crush injuries, wounds near bone/joint, and immunocompromised patients. (American Academy of Pediatrics) 2
First‑line agent: amoxicillin‑clavulanate for animal bites, human bites, and contaminated wounds. (American Academy of Pediatrics) 2
For penicillin‑allergic patients, use doxycycline (age‑appropriate) or a fluoroquinolone + metronidazole/clindamycin. (American Academy of Pediatrics) 2
Avoid first‑generation cephalosporins, macrolides, clindamycin monotherapy, and penicillinase‑resistant penicillins alone because of poor activity against Pasteurella multocida and Eikenella corrodens. (American Academy of Pediatrics) 2
Prophylactic antibiotic courses should last 3–5 days; do not prescribe antibiotics for bite wounds presenting ≥24 hours after injury without signs of infection. (American Academy of Pediatrics) 2
Cat bites have a ~50 % infection rate (vs. 15‑20 % for dog bites) and frequently involve P. multocida; always prescribe prophylactic antibiotics. (American Academy of Pediatrics) 2

Wounds <8 hours old and clean may be closed primarily or approximated with Steri‑Strips. (American Academy of Pediatrics) 2
Wounds >8 hours old or contaminated should NOT be closed primarily; use delayed primary closure (2‑5 days) or heal by secondary intention. (American Academy of Pediatrics) 2
Infected wounds should never be closed, regardless of timing. (American Academy of Pediatrics) 2
Facial wounds may be closed primarily even after 8 hours if meticulous irrigation and prophylactic antibiotics are provided. (American Academy of Pediatrics) 2
Hand wounds should avoid primary closure due to high infection risk; use Steri‑Strips and delayed closure. (American Academy of Pediatrics) 2
Human bite wounds (except facial) should not be sutured; approximate with Steri‑Strips to allow drainage. (American Academy of Pediatrics) 2

Cover clean wounds with occlusive dressings (film, petrolatum, hydrogel) to promote healing; these are superior to dry dressings. (American Heart Association) 1
Apply a thin layer of antibiotic ointment to superficial wounds only if the patient has no allergy. (American Heart Association) 1
Antibiotic or antibacterial dressings do not improve healing or reduce infection rates in clean wounds. (American Heart Association) 1

Arrange a follow‑up contact (phone or office visit) within 24 hours for all significant pediatric wounds. (American Academy of Pediatrics) 2
Parents should return promptly if any of the following occur: increasing redness or swelling, foul‑smelling drainage, worsening pain (especially near joints or bone), fever, or red streaking from the wound. (American Heart Association) 1

Early antibiotic therapy prevents infection in high‑risk bites (hand injuries, cat bites). (American Heart Association) 1
Assess rabies risk based on species, geography, attack circumstances, and animal vaccination status; if exposure is suspected, give rabies immune globulin on day 0 and rabies vaccine on days 0, 3, 7, 14, 28. (American Academy of Pediatrics) 2

Clenched‑fist injuries require immediate hand‑surgery consultation due to high risk of septic arthritis and osteomyelitis. (American Academy of Pediatrics) 2
Amoxicillin‑clavulanate provides coverage for the polymicrobial flora typical of human bites (Streptococcus, Staphylococcus, Eikenella corrodens, anaerobes). (American Academy of Pediatrics) 2

Barb‑wire, soil‑contaminated, or crush injuries require immediate antibiotic therapy. (American Academy of Pediatrics) 2
Moderate contamination: cefazolin; severe soil contamination: cefazolin + penicillin for Clostridium coverage. (American Academy of Pediatrics) 2
Continue antibiotics for 48‑72 hours; extend only if infection develops. (American Academy of Pediatrics) 2

All facts are presented in English, with patient identifiers generalized to maintain privacy.