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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), accounting for >5% of all ED visits annually.4 A 2014 study found that 17.2 million medical visits to hospital and outpatient settings in the United States were related to acute wounds.5
Complications of wound care that may lead to malpractice claims include missed foreign bodies, wound infection, joint capsule violation, and failure to detect nerve or tendon injury.6 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 complication has been found to account for 3% to 11% of all dollars paid out in malpractice claims.6
This issue of Evidence-Based Urgent Care reviews the evaluation and treatment of minor traumatic wounds in urgent care (UC), with a focus on evidence-based recommendations for the evaluation, cleansing, and repair of wounds.
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Following are the most informative references cited in this paper, as determined by the authors.
5. Steiner CA, Karaca Z, Moore BJ, et al. Surgeries in hospital-based ambulatory surgery and hospital inpatient settings, 2014: Statistical Brief #223. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. U.S. Agency for Healthcare Research and Quality; 2017. Updated July 20, 2020. Accessed July 10, 2022. (Review)
6. * Pfaff JA, Moore GP. Reducing risk in emergency department wound management. Emerg Med Clin North Am. 2007;25(1):189-201. (Review) DOI: 10.1016/j.emc.2007.01.009
9. Rui P, Kang K. National Hospital Ambulatory Medical Care Survey: 2017 emergency department summary tables. 2017. Accessed July 10, 2022. (Government data set)
10. * Singer AJ, Thode HC, Jr., Hollander JE. National trends in ED lacerations between 1992 and 2002. Am J Emerg Med. 2006;24(2):183-188. (Retrospective systematic review) DOI: 10.1016/j.ajem.2005.08.021
20. * Davis J, Czerniski B, Au A, et al. Diagnostic accuracy of ultrasonography in retained soft tissue foreign bodies: a systematic review and meta-analysis. Acad Emerg Med. 2015;22(7):777-787. (Systematic review and meta-analysis; 17 articles) DOI: 10.1111/acem.12714
22. * Singer AJ, Mach C, Thode HC, Jr., et al. Patient priorities with traumatic lacerations. Am J Emerg Med. 2000;18(6):683-686. (Prospective observational survey; 724 patients) DOI: 10.1053/ajem.2000.16312
26. Berk WA, Osbourne DD, Taylor DD. Evaluation of the ‘golden period’ for wound repair: 204 cases from a Third World emergency department. Ann Emerg Med. 1988;17(5):496-500. (Prospective observational study; 372 patients) DOI: 10.1016/s0196-0644(88)80246-4
55. Swaminathan A. Local Anesthetic Systemic Toxicity (LAST). Updated May 18, 2017. Accessed July 10, 2022. (Review)
92. * Nakamura Y, Daya M. Use of appropriate antimicrobials in wound management. Emerg Med Clin North Am. 2007;25(1):159-176. (Review) DOI: 10.1016/j.emc.2007.01.007
99. * Toon CD, Ramamoorthy R, Davidson BR, et al. Early versus delayed dressing removal after primary closure of clean and clean-contaminated surgical wounds. Cochrane Database Syst Rev. 2013(9):CD010259. (Meta-analysis; 4 randomized controlled trials, 280 patients) DOI: 10.1002/14651858.CD010259.pub3
108. *Sabatino F, Moskovitz JB. Facial wound management. Emerg Med Clin North Am. 2013;31(2):529-538. (Review) DOI: 10.1016/j.emc.2013.01.005
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Keywords: wound, laceration, traumatic wound, wound care, wound management, wound closure, wound irrigation, wound cleansing, golden period, digital nerve block, topical anesthetics, EMLA, suture, suturing, suturing techniques, tissue adhesive, adhesive strips, staples, hair apposition, facial laceration, eyelid laceration, cheek laceration, intraoral laceration, lip laceration, finger laceration
Price: $59
+4 Credits!
Keith Pochick, MD, FACEP
Attending Physician, Urgent Care
Jordan P. Harry, MD; Lorilea Johnson, FNP-BC, DNP
August 1, 2022
September 1, 2025
4 AMA PRA Category 1 Credits™. Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME and 1 Pharmacology CME credits
CME Information
Date of Original Release: August 1, 2022. Date of most recent review: July 10, 2022. Termination date: August 1, 2025.
Accreditation: EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the ACCME.
Credit Designation: EB Medicine designates this enduring material for a maximum of 4 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits and 1 Pharmacology CME credit, subject to your state and institutional requirements.
AOA Accreditation: Evidence-Based Urgent Care is eligible for 4 Category 2-A or 2-B credit hours per issue by the American Osteopathic Association.
Needs Assessment: The need for this educational activity was determined by a practice gap analysis; a survey of medical staff; review of morbidity and mortality data from the CDC, AHA, NCHS, and ACEP; and evaluation responses from prior educational activities for urgent care and emergency medicine physicians.
Target Audience: This internet enduring material is designed for physicians, physician assistants, nurse practitioners, and residents in the urgent care and family practice settings. Goals: Upon completion of this activity, you should be able to: (1) identify areas in practice that require modification to be consistent with current evidence in order to improve competence and performance; (2) develop strategies to accurately diagnose and treat both common and critical ED presentations; and (3) demonstrate informed medical decision-making based on the strongest clinical evidence.
CME Objectives: Upon completion of this activity, you should be able to: (1) describe the initial steps of wound evaluation in the urgent care setting; (2) prepare a wound for closure, including irrigation and anesthesia; (3) select the appropriate methods and materials for wound closure; and (4) identify wounds that are at high risk for complications.
Discussion of Investigational Information: As part of the activity, faculty may be presenting investigational information about pharmaceutical products that is outside Food and Drug Administration approved labeling. Information presented as part of this activity is intended solely as continuing medical education and is not intended to promote off-label use of any pharmaceutical product.
Faculty Disclosure: It is the policy of EB Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME activities. All faculty participating in the planning or implementation of a CME activity are expected to disclose to the participants any relevant financial relationships and to assist in mitigating the relationships. In compliance with all ACCME accreditation requirements and policies, all faculty for this CME activity were asked to complete a full financial disclosure statement. The information received is as follows: Update Contributors (August 2022): the author and Editor-in-Chief, Dr. Keith Pochick; and peer reviewers, Dr. Jordan Harry and Lorilea Johnson, report no relevant financial relationships with ineligible companies. Original Contributors (December 2021): The information received is as follows: Dr. Barnes, Dr. Baron, Dr. D'Amore, Dr. Maccagnano, Dr. Propersi, Dr. Reyes, Dr. Shah, and their related parties report no relevant financial interest or other relationship with the manufacturer(s) of any commercial product(s) discussed in this educational presentation.
Commercial Support: This issue of Evidence-Based Urgent Care did not receive any commercial support.
Earning Credit: Go online to www.ebmedicine.net/CME and click on the title of the test you wish to take.When completed, a CME certificate will be emailed to you.
Hardware/Software Requirements: You will need a computer, tablet, or smartphone to access the online archived article, podcast, and CME test.
Additional Policies: For additional policies, including our statement of conflict of interest, source of funding, statement of informed consent, and statement of human and animal rights, visit www.ebmedicine.net/policies.
Pediatric Wound Care and Management in the Emergency Department