Suturing in the ED-pocketcard - University of Wisconsin ...

1 Suturing in the ED. Suture Trade Knot Tensile Tissue Wound security (A = absorbable, name security strength reactivity (50% tensile N = nonabsorbable) strength). Nylon (N) Ethilon Good Good + Non absorbable Polypropylene (N) Prolene Least Best ~0 Non absorbable Silk (N) Silk Best Least +++ Non absorbable Chromic gut (A) Chromic Good Fair +++++ ~ 2 wk gut Polyglactin (A) Vicryl Good Good +++ ~ 4 wk Polyglycolic acid (A) Dexon Best Good ++ 6 8 wk Polyglyconate (A) Maxon Fair Best ++ 6 8 wk 2 Octyl DERMA N/A Fair ~0 3 7 d cyanoacrylate BOND. Agent Trade Class Concentrations, Maximum Onset Duration name % safe dose Lidocaine with Xylocaine Amide mg/kg ~5 1 2 h epinephrine 7 mg/kg min h Bupivicaine with Marcaine Amide 2 mg/kg ~5 4 8 h epinephrine 3 mg/kg min 8 16 h Procaine with Novocaine Ester 7 mg/kg ~5 15 45 min epinephrine 9 mg/kg min 30 90 min Body part Suture size Remove sutures on day: Scalp Staples or 4 0 7.

2 Face 5 0, 6 0 4 5. Chest 3 0, 4 0 7 10. Back 3 0, 4 0 10 14. Forearm 4 0, 5 0 10 14. Finger/hand 5 0 7 10. Lower extremity 4 0, 5 0 10 12. University of Wisconsin Emergency Medicine Tetanus prophylaxis : If tetanus booster within last 5 years, no booster needed If last booster more than 5 years ago, administer Td (tetanus . diphtheria toxoid) mL IM. If no history of tetanus series, administer TIG (tetanus immune globulin) 250 units IM and first dose of tetanus series, Td mL IM. Td booster is due every 10 years Clinical Pearls: Document! Draw pictures and diagrams when possible. Document wound length, shape, type of suture used, type of knot thrown, and number of stitches.

3 Always document that a laceration has been explored through the anatomy's full active range of motion and whether any deep structures were injured. Antibiotics are not routinely given for lacerations when irrigated and explored thoroughly. Patients should be given firm instructions, however, on signs of infection, particularly for lacerations of the hand. All wounds scar. Wounds that are sutured achieving edge approximation make smaller scars. Scars do not take on their final appearance for >1 year from date of injury. Advise patients to minimize scar appearance by 1. Always applying sunscreen over the scar, even on cloudy days.

4 2. Using a lotion with vitamin E over the scar. University of Wisconsin Emergency Medici