Pediatric emergency medicine trisk 843

Triage Considerations Children with minor trauma should be assessed for associated significant injuries Injuries that compromise airway, breathing, or circulation (systemically or locally, such as in a limb) require immediate attention Wound management should not preempt care of more life-threatening injuries If there are no significant injuries, the focus should move to addressing hemostasis and pain control Application of topical anesthetics and administration of oral analgesics can be initiated at triage Once these measures have been initiated, the emergency provider should aim for appropriate and timely wound repair Clinical Assessment History In the evaluation of a laceration, it is important to understand the mechanism of the injury because this has a direct impact on management plans For instance, if the wound was caused by an animal bite, the likelihood of infection and devitalized tissue is higher, thus wound closure may be avoided and healing by secondary intention may be preferred in selected areas (Chapter 94 Infectious Disease Emergencies ) Similarly, a wound caused by a blunt object may be associated with an underlying fracture or crush injury These injuries are inherently more complicated and may require surgical consultation and hospital admission A wound caused by a sharp or projectile object may cause deeper tissue or vascular injury It is also important to determine the age of the wound, as well as the possibility of a foreign body in the wound, since these factors also need to be considered in the management of the wound TABLE 110.1 TETANUS PROPHYLAXIS Prior tetanus toxoid immunization (doses) Clean minor wound Uncertain (or less Tetanus toxoid–containing than 3) vaccine a Three or more Td (most recent more than 10 yrs ago) Three or more None (most recent between and 10 yrs) All other wounds Tetanus toxoid–containing vaccine and TIG or TAT Td Td a If the child is