Emergency Department Treatment of Lacerations

Initial Assessment and Preparation

The American Academy of Pediatrics recommends evaluating the wound for size, depth, contamination, and location to determine the appropriate closure method 2
Clean the wound thoroughly with irrigation using tap water or saline solution (100-1000 mL) to reduce infection risk 2
Apply adequate anesthesia before wound manipulation, such as topical anesthetics like LET (lidocaine, epinephrine, tetracaine) or lidocaine injection, with techniques like buffering with bicarbonate and slow injection to minimize pain 1

The American Academy of Pediatrics suggests that wound closure strips (Steri-Strips) can be used for low-tension areas, providing a painless closure and being less expensive than tissue adhesives 1
For hand lacerations, consider the functional aspects of the thumb and the need for durability in the closure method, as recommended by the American College of Radiology 3

Provide pain management with acetaminophen and/or ibuprofen, as recommended by the Praxis Medical Insights 2
Apply ice packs to reduce swelling and instruct the patient to monitor for signs of infection (increased pain, redness, swelling, purulent discharge) 2