Title Choose one Title
Laceration
Location Choose one First line
Forehead Eyebrow Scalp Chin Cheek Lip Ear Nose Neck Hand Finger Palm Forearm Upper arm Elbow Knee Thigh Leg Foot Sole of the foot Toe Trunk Back Buttock Genital area
Side Choose one First line
(right) (left)
Wound Choose one
Simple linear laceration through the skinDefault Gaping laceration into the subcutaneous tissue Contaminated laceration Stellate laceration with irregular edges Flap laceration Deep laceration involving structures below the skin Laceration crossing the vermilion border
Length Choose one Joins the line above
0.5 cm 1 cm 1.5 cm 2 cm 2.5 cm 3 cm 4 cm 5 cm 6 cm 7 cm 8 cm 10 cm
Exploration present Choose any
a foreign body (removed) tendon involvement a possible nerve or vessel injury exposed bone or joint capsule
Exploration absent Choose any
foreign bodyDefault tendon involvementDefault nerve or vessel injuryDefault bone or joint exposureDefault
Repair elsewhere Choose one
Sent to the emergency department given tendon involvement Sent to the emergency department given a possible nerve or vessel injury Sent to the emergency department given exposed bone or joint involvement Sent to the emergency department for repair under sedation Referred to plastic surgery for repair given a complex facial laceration
Consent Choose one
Verbal consent obtained from the caregiver after discussing benefits, risks including infection and scarring, and alternativesDefault Written consent obtained from the caregiver after discussing benefits, risks including infection and scarring, and alternatives
Anesthesia Choose one
Anesthetized with topical LET, then buffered lidocaine infiltrationDefault Anesthetized with topical LET Anesthetized with buffered lidocaine infiltration Anesthetized with lidocaine with epinephrine infiltration Digital block with lidocaine No anesthesia needed for this closure
Comfort Choose any
Comfort positioning with the caregiver and distraction used during the repair Held still safely with help from staff
Irrigation Choose one
Irrigated with normal saline and prepped in sterile fashionDefault Irrigated with copious normal saline and debris removed given contamination
Closure Choose one
Closed with simple interrupted nonabsorbable suturesDefault Closed with a running nonabsorbable suture Layered closure (intermediate repair) with absorbable deep sutures and nonabsorbable skin sutures Closed with absorbable sutures Closed with tissue adhesive Closed with adhesive strips Closed with skin staples
Suture Choose one Joins the line above
of 4-0 nylon of 5-0 nylon of 6-0 nylon of 5-0 Prolene of 6-0 Prolene
Absorbable suture Choose one Joins the line above Not in the note with these choices
of 5-0 fast-absorbing gut of 6-0 fast-absorbing gut of 4-0 Vicryl Rapide of 5-0 Vicryl Rapide
Number placed Choose one Joins the line above
(1 placed) (2 placed) (3 placed) (4 placed) (5 placed) (6 placed) (7 placed) (8 placed) (9 placed) (10 placed) (11 placed) (12 placed)
Dressing Choose one
Antibiotic ointment and a clean dressing appliedDefault Dry dressing applied
Tolerance Choose one
Tolerated well without complication; edges well approximated with good hemostasisDefault Tolerated with some distress but without complication; edges well approximated with good hemostasis
Tetanus Choose one
Tetanus immunization up to dateDefault DTaP given today as tetanus immunization was not current Td given today as tetanus immunization was not current Tdap given today as tetanus immunization was not current Tetanus immune globulin and vaccine given for a tetanus-prone wound without a completed primary series Tetanus immunization not current; vaccine declined after discussion
Antibiotic Choose one
No antibiotics needed Started Keflex given a heavily contaminated wound Started Clindamycin given a heavily contaminated wound and Penicillin allergy
Follow-up Choose one
in 4-5 days in 7 daysDefault in 7-10 days in 10 days in 12-14 days in 2 days as needed
Follow-up reason Choose one Joins the line above
for suture removalDefault for staple removal for a wound check
Counseling paragraph Choose one Paragraph
Keep the wound clean and dry for the first 24 hours, then brief showers are fine; avoid swimming, baths, or soaking until the sutures are removed. Recommended supportive care with tylenol or motrin as needed for pain, with an emphasis on antibiotic ointment and a clean dressing until the edges have sealed, and changing the dressing when it gets wet or dirty. Removing the sutures on time helps prevent marks on the skin; if one comes out early, cover the wound with tape until it is checked. After removal, protect the area from injury for about a month and let any scab fall off on its own. Return precautions given including redness spreading from the wound, pus, increasing pain or swelling, fever, the wound opening, a suture coming out early, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.Default Keep the wound clean and dry for the first 24 hours, then brief showers are fine; avoid swimming, baths, or soaking until the staples are removed. Recommended supportive care with tylenol or motrin as needed for pain, with an emphasis on gentle washing and antibiotic ointment along the staple line. Removing the staples on time helps prevent marks on the skin. After removal, protect the area from injury for about a month and let any scab fall off on its own. Return precautions given including redness spreading from the wound, pus, increasing pain or swelling, fever, the wound opening, a staple coming out early, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions. The sutures will dissolve on their own and do not need to be removed. Keep the wound clean and dry for the first 24 hours, then brief showers are fine; avoid swimming, baths, or soaking while the wound heals. Recommended supportive care with tylenol or motrin as needed for pain, with an emphasis on antibiotic ointment and a clean dressing until the edges have sealed. Protect the area from injury for about a month and let any scab fall off on its own. Return precautions given including redness spreading from the wound, pus, increasing pain or swelling, fever, the wound opening, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions. The skin glue will peel off on its own as the wound heals. Keep it dry for the first 4 hours, then brief showers are fine; avoid swimming, baths, or soaking until the glue has fallen off. Recommended supportive care with tylenol or motrin as needed for pain, with an emphasis on not putting ointments or creams on the glue and not picking or scratching at it. Protect the area from injury for about a month. Return precautions given including redness spreading from the wound, pus, increasing pain or swelling, fever, the wound opening, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions. The adhesive strips will loosen and fall off on their own as the wound heals. Recommended supportive care with tylenol or motrin as needed for pain, with an emphasis on keeping the strips clean and dry and not pulling them off early. Protect the area from injury for about a month. Return precautions given including redness spreading from the wound, pus, increasing pain or swelling, fever, the wound opening, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.
Counseling Not in the note with these choices
Discussed the need for emergency evaluation today. Caregiver expressed understanding and agreement with plan. Answered all questions.
Counseling Not in the note with these choices
Return precautions given including redness spreading from the wound, pus, increasing pain or swelling, fever, the wound opening, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.
Note when inserted as is
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Laceration repair
• Simple linear laceration through the skin
• Wound explored without foreign body, tendon involvement, nerve or vessel injury, or bone or joint exposure
• Verbal consent obtained from the caregiver after discussing benefits, risks including infection and scarring, and alternatives
• Anesthetized with topical LET, then buffered lidocaine infiltration
• Irrigated with normal saline and prepped in sterile fashion
• Closed with simple interrupted nonabsorbable sutures
• Antibiotic ointment and a clean dressing applied
• Tolerated well without complication; edges well approximated with good hemostasis
• Tetanus immunization up to date
• Follow up in 7 days for suture removal
Keep the wound clean and dry for the first 24 hours, then brief showers are fine; avoid swimming, baths, or soaking until the sutures are removed. Recommended supportive care with tylenol or motrin as needed for pain, with an emphasis on antibiotic ointment and a clean dressing until the edges have sealed, and changing the dressing when it gets wet or dirty. Removing the sutures on time helps prevent marks on the skin; if one comes out early, cover the wound with tape until it is checked. After removal, protect the area from injury for about a month and let any scab fall off on its own. Return precautions given including redness spreading from the wound, pus, increasing pain or swelling, fever, the wound opening, a suture coming out early, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.