Section of Pediatric Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA.
Pediatrics in Review (Impact Factor: 0.82). 08/2010; 31(8):326-34; quiz 334. DOI: 10.1542/pir.31-8-326
Source: PubMed
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    ABSTRACT: Puncture wounds are common in children, and most are uncomplicated. For children who have a delayed presentation or signs of infection, consider the possibility of a retained foreign body. The diagnosis of P aeruginosa osteochondritis should be considered in any child who exhibits persistent signs and symptoms after puncture wounds; timely use of laboratory tests, radiologic imaging, and orthopedic referral is required.
    Pediatrics in Review 02/1999; 20(1):21-3. DOI:10.1542/pir.20-1-21 · 0.82 Impact Factor
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    ABSTRACT: Objective: Pretreatment of lacerations with topical anesthetics reduces the pain of subsequent anesthetic injection yet requires time. This study was conducted to determine the ability of triage nurses to identify lacerations necessitating closure and pretreat them with a topical anesthetic and to compare the pain levels of lidocaine injection in lacerations pretreated with LET (lidocaine 2%, epinephrine 1:1,000, tetracaine 2%) vs a placebo. Methods: This was a double-blind, randomized clinical trial that included consecutive emergency department patients aged ≥ 1 year with clean, non-bite lacerations ≤ 6 hours old. At triage the lacerations were randomized to LET solution or a placebo containing epinephrine 1:1,000. At examination an emergency practitioner assessed the laceration edges for the presence of blanching and adequacy of anesthesia to a 27-gauge needlestick. At the practitioner's discretion, supplemental lidocaine was infiltrated through the wound and the patient (or guardian) recorded the pain of infiltration on a 100-mm visual analog scale marked “most pain” at the high end. The mean levels of pain of lidocaine infiltration were compared between groups with a t-test and the proportions of adequately anesthetized wounds were compared with a χ2 test. A sample of 40 patients had 80% power to detect a 20-mm between-group difference in the pain of injection (α= 0.05). Results: Of 43 patients enrolled (mostly children and males), 22 received LET and 21 placebo. The groups were similar for baseline characteristics. Lacerations in the LET group were more frequently adequately anesthetized (46% vs 14%, p = 0.03), and LET patients experienced less pain from injection than controls (22 mm vs 42 mm, p = 0.02). Conclusions: Application of LET by triage nurses is more effective than placebo in adequately anesthetizing simple lacerations in normal hosts and decreases the pain of local anesthetic infiltration.
    Academic Emergency Medicine 06/2000; 7(7):751 - 756. DOI:10.1111/j.1553-2712.2000.tb02262.x · 2.01 Impact Factor
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    ABSTRACT: Study objective: We evaluate a new technique of treating scalp lacerations, the hair apposition technique (HAT). After standard cleaning procedures, hair on both sides of a laceration is apposed with a single twist. This is then held with tissue adhesives. HAT was compared with standard suturing in a multicenter, randomized, prospective trial. Methods: All linear lacerations of the scalp less than 10 cm long were included. Severely contaminated wounds, actively bleeding wounds, patients with hair strand length less than 3 cm, and hemodynamically unstable patients were excluded. Patients were randomized to receive either HAT or standard suturing, and the time to complete the wound repair was measured. All wounds were evaluated 7 days later in a nonblinded manner for satisfactory wound healing, scarring, and complications. Results: There were 96 and 93 patients in the study and control groups, respectively. Wound healing trended toward being judged more satisfactory in the HAT group than standard suturing (100% versus 95.7%; P=.057; effect size 4.3%; 95% confidence interval 0.1% to 8.5%). Patients who underwent HAT had less scarring (6.3% versus 20.4%; P=.005), fewer overall complications (7.3% versus 21.5%; P=.005), significantly lower pain scores (median 2 versus 4; P<.001), and shorter procedure times (median 5 versus 15 minutes; P<.001). There was a trend toward less wound breakdown in the HAT group (0% versus 4.3%; P=.057). When patients were asked whether they were willing to have HAT performed in the future, 84% responded yes, 1% responded no, and 15% were unsure. Conclusion: HAT is equally acceptable and perhaps superior to standard suturing for closing suitable scalp lacerations. Advantages include fewer complications, a shorter procedure time, less pain, no need for shaving or removal of stitches, similar or superior wound healing, and high patient acceptance. HAT has become our technique of choice for suitable scalp lacerations.
    Annals of Emergency Medicine 07/2002; 40(1):19-26. DOI:10.1067/mem.2002.125928 · 4.68 Impact Factor