Acute Traumatic Wounds: Evaluation, Cleansing, and Repair in the ED - Trauma EXTRA Supplement (Trauma CME and Pharmacology CME) -

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Publication Date: December 2021 (Volume 23, Supplement 12)

CME Credits: 4 AMA PRA Category 1 Credits™. CME expires 12/15/2024. This course is included with an Emergency Medicine Practice subscription

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME and 1 Pharmacology CME credits, subject to your state and institutional approval.

Authors

Peer Reviewer

Editor-in-Chief

Abstract

Traumatic wounds are a common presentation in the emergency department. While most minor traumatic wounds and lacerations will heal well, appropriate management is required to preserve function and cosmesis as well as to prevent infection and other complications. This supplement reviews evidence-based recommendations for management of acute traumatic wounds, including evaluation, cleansing, anesthesia, selection of closure methods and materials, and post-repair instruction. Management of high-risk wounds and special considerations for the evaluation and repair of facial lacerations are also reviewed.

Introduction

Many of the wound care techniques used today were first practiced by ancient Egyptian, Greek, and Roman physicians, but certain aspects of wound management have evolved as medical technology has improved and new evidence has emerged, particularly in recent decades.^1-3 Traumatic wounds are among the most common conditions treated in the emergency department (ED). Approximately 7 million patients in the United States require treatment for traumatic lacerations each year, which is a rate of 1 laceration every 4.5 seconds. These injuries account for >5% of all ED visits annually.⁴ The most common location of lacerations is the upper extremity (35%), followed by lacerations to the face (28%), trunk (14.5%), lower extremity (12.5%), and head/neck (10%).^5,6

Complications of wound care that may lead to malpractice claims include missed foreign bodies, wound infection, joint capsule violation, or failure to detect nerve or tendon injury.⁷ Although the economic burden of an individual malpractice case may be relatively small, the overall financial impact of these claims is significant due to the large numbers of patients who present with wounds; litigation associated with wound management complications accounted for 3% to 11% of all dollars paid out in malpractice claims.⁷

This issue of Emergency Medicine Practice: Trauma Extra! reviews the evaluation and treatment of minor traumatic wounds in the ED, with a focus on evidence-based recommendations for the evaluation, cleansing, and repair of wounds.

For a detailed review of wound management in pediatric patients, see the October 2017 issue of Pediatric Emergency Medicine Practice titled, “Pediatric Wound Care and Management in the Emergency Department.”