To be perfectly honest John, I hardly ever suture submental lacerations in
kids. They're usually quite minor, the skin flaps invariably oppose well
with digital pressure, then steristrips will hold the flaps nicely over the
convex surface of the hairless chin, and finally, the resulting scar is not
really an aesthetic issue because of its position.
Yes, you do need the kid to half-cooperate with you as you carry out this
largely painless procedure, and yes, very young kids can't really
distinguish between what is painful and what is just frightening. That said,
our nurses - and parents generally - are usually quite happy to restrain a
kid for a largely painless procedure, but are not so keen on restraint for a
clearly painful procedure.
So, as Paul suggests, you have to be quite versatile in your surgical and
anaesthetic repertoire when it comes to kids' wounds, but in this particular
case I would avoid both (surgery and anaesthesia) by using something much
simpler. There are exceptions of course, and I've rarely had to suture a
kid's chin in my time, but very rarely.
Adrian
----- Original Message -----
From: "John Ryan" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, February 12, 2007 10:53 PM
Subject: Re: LAT gel
> What ever happened to TAC (tetracaine, adrenaline, cocaine) ? It worked
> nicely for 'simple' lacerations under the chin in kids, you know; the
> toddler who falls on his chin. One young Cian Ryan was happy to have wound
> sutured by Dad using TAC. (tidy result also!). I seem to remember only a
> few places produced it (? Plymouth and Cambridge) but it then became
> financially non viable to produce. Is anyone still using it ?
>
> John Ryan
>
>
> ----- Original Message -----
> From: "Adrian Fogarty" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Monday, February 12, 2007 2:00 PM
> Subject: Re: LAT gel
>
>
>> I was intrigued by the bit "simple lacerations of the head, neck, limbs
>> or
>> trunk." I don't think I've ever seen a "simple" laceration of the neck
>> or
>> trunk. Pretty much every wound I see on the neck or trunk is an incision
>> caused by a sharp implement, i.e. a penetrating wound. "Simple
> lacerations"
>> they are not, particularly if you ever see them on a child.
>>
>> But back to the subject, and the Best Bets in particular. All this
> research
>> is doing is comparing two inferior forms of management - local
> infiltration
>> versus gel application - to see which is the most inferior. Many of the
>> papers are studying the "wrong" age group, i.e. older children. The
>> technique excludes digits, a big area in paediatric wound management
>> (particularly in the under twos). And finally, I don't think the "tissue
>> distortion" argument is significant.
>>
>> AF
>>
>> ----- Original Message -----
>> From: "Atkinson, Paul" <[log in to unmask]>
>> To: <[log in to unmask]>
>> Sent: Monday, February 12, 2007 12:01 PM
>> Subject: Re: LAT gel
>>
>> > We use it at Addenbrooke's with mixed success - took a year and lots of
>> > paperwork for approval
>> >
>> >
>> >
>> > Guideline attached - may be of use
>> >
>> >
>> >
>> > Paul
>> >
>> >
>> >
>> > Dr Paul Atkinson MRCP FCEM
>> >
>> > Consultant in Emergency Medicine
>> >
>> >
>> >
>> > Box 87, Addenbrooke's Hospital
>> >
>> > Cambridge University Hospitals NHS Foundation Trust
>> >
>> > Cambridge CB2 2QQ
>> >
>>
>>
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