Or a bit sad.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of McCormick Simon Dr,
Consultant, A&E
Sent: 13 February 2007 22:23
To: [log in to unmask]
Subject: Re: LAT gel[Scanned]
Its great isn't it. Two of our most opinionated (and I mean that
nicely) contributors having completely opposing views on what seems such
a simple subject. That's what makes medicine so much fun.
Simon
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Rowley Cottingham
Sent: 13 February 2007 22:04
To: [log in to unmask]
Subject: Re: LAT gel
Hang on Adrian, weren't you the one criticising poor practice?
Steristrips
are a real Room 101 special for me, along with pethidine, tramadol and
weight-bearing acromio-clavicular joint Xrays. Steristrips have one use
and one use only - closing pretibial lacerations. They are otherwise a
great way to hide a wound to allow it to heal by secondary intention,
completely unhindered by any semblance of closure. They are
spectacularly hopeless for facial lacerations and particularly the
pouting central submental laceration in a drooling, teething toddler.
Which just happens to be the main age group for injury, of course. It is
also a central injury and thus more prone to become hypertrophic or
frankly keloid. These wounds DO need careful attention and closure, and
the nicest way to get a fuss-free result is to use the Mum swabs with
lidocaine, doc swiftly glues one-two routine.
Steristrips? Just say no!
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Adrian Fogarty
Sent: 13 February 2007 01:29
To: [log in to unmask]
Subject: Re: LAT gel
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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