Ninety minutes before my Sunday night shift, my two-year-old, Titan, comes screaming up the stairs looking like a scene out of a slasher horror movie. His older sister sheepishly admitted to chasing him into the edge of a door frame. We created an ED bed on our kitchen counter and slipped a pillowcase up his arms, behind him, with him laying on it, to help restrain him, telling him it was a superhero cape.
I wanted to use Dermabond, but I couldn’t get the wound edges to approximate as I wanted them to. If the wound was above the hairline, I could have used the stapler. Recruiting his four older siblings and my wife to help soothe him and hold him down, I anesthetized the wound with injectable 1% lidocaine, irrigated it with sterile saline, 60cc syringe, and a splash guard, prepped it with drapes and betadine and then closed it, using 6-0 Ethilon on a P-3 needle.
He took it like a champ!
It was nice not to have to take him to the ER, and it was a good experience for my family. I enjoyed showing them what I do as an ER doctor. I had everything I needed that I am accustomed to using in the ER. The evening was saved. Time and money was saved. I maintained my autonomy, caring for my own child. I was affordably prepared without swiping materials from the hospital, maintaining my integrity.
I believe every physician would be wise to prepare for frequently occurring soft tissue injuries in their loved ones.
Have you ever had the painful experience of taking a lacerated loved one to the ER, taking precious time off work, waiting hours, and paying thousands to watch someone do what you could have done at home or the lake or beach or cabin or ball game or wherever the injury occurred?
Family, friends, and neighbors expect physicians (and for that matter, PAs, NPs, dentists, veterinarians) to be equipped to manage injuries. I find it to be the most common situation of having skills, but lacking supplies is laceration management. We need sterile, hospital-grade, disposable wound repair kits with the high-quality materials we are accustomed to working with.
Most of us are employed or contract with a hospital or clinic. Some might rationalize taking materials from work, but in most cases, this is dishonest. Some of us own our practice but are not stocked with the breadth of supplies needed, falling short of producing the best results for a variety of wounds.
According to Cost Helper, individuals can expect to be charged $200-$3,000 for laceration repair, depending on insurance coverage, the provider, the injury, and the complexity of the repair. If you have the skillset, wouldn’t you want to be equipped to manage it yourself and put that money elsewhere?
Assembling a comprehensive suture kit, ordering in minimum quantities from medical supply companies, can cost over $1,500, leaving plenty of unused medical supplies. There are companies that will assemble kits for you, personalizing it down to your glove size and wound closure device preferences (sutures, Dermabond, stapler, steri-strips, etc.). And yes, you can add lidocaine.
Given our litigious society, some physicians are concerned about liability. We should exercise good judgment. Chances of being sued by a loved one are slim. Some wouldn’t warrant the risk. However, I became a doctor to help people, especially my family and friends. Some of my most rewarding experiences have been caring for neighbors at home and abroad at no expense to them. In addition, it’s a great opportunity to show our families what we do as physicians.
You’ve probably been approached by a family member or friend with a laceration. You have the skills to repair it but were not prepared with adequate supplies.
Be prepared for wherever the unexpected occurs with kits in your home and vehicle. You’ll thank yourself later for being prepared, and your loved ones will praise your name for saving them time, money, and sparing them anxiety.
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