S: Adorable 2-year-old girl frantically rushed by her mother to the pediatric ER after falling from the top bunk bed while clutching a ceramic statue of the Virgin Mary. The statue shattered, slicing open the girl's right temple.
O: T 98.4 . . BP 85/50. . HR 115. . RR 24. . O2 sat 99%
5 cm laceration on R temple approximately 1cm in depth with no discernible ceramic fragments embedded. Subcutaneous tissue and temporalis fascia exposed. Bleeding well controlled [that is to say, until I started stitching...]
A/P:
1. Patient placed under conscious sedation with ketamine.
2. Laceration vigorously irrigated with 0.9% saline solution, sterilized with betadine, anesthetized using 1% lidocaine with epinephrine. Subcutaneous closure with 5-0 vicryl. Skin closure with 8 interrupted stitches of 6-0 nylon.
[Have you ever experienced the delight of using super super thin nylon suture the same color as your squirming pediatric patient's hair??? Exhale a little too enthusiastically and the suture blows all the way across the room. But the results were gorgeous. I could have been a plastic surgeon]
3. Mother advised to keep the wound clean & dry, have stitches removed in 7 days, and strongly urged to use plastic religious icons instead of ceramic.
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