I'm Anton Hellman.

I'm Justin Morganstern.

And this is the Journal Jam podcast.

EM cases is part of Shremie, the Schwartz-Riseman Emergency Medicine Institute.

That's the nonprofit organization dedicated to improving EM care through high-quality research and education. The opinions expressed on this podcast are intended for general information and educational purposes only and should not be used to diagnose treat or prevent any medical condition, nor should they be used as a substitute for medical advice from qualified practicing physician. Unless stated otherwise, the opinions expressed by the hosts or guests are made in their individual capacity, not on behalf of the Institute nor medicine cases.

Okay, here's the question. So, have you ever seen a patient in the ED with a laceration?

It's incredible, actually, that we treat probably millions of people with lacerations in the ED every year and seem to hardly ever talk about the evidence for what we do or do not do to them. There are literally dozens of questions that I'm not sure

we have great answers for. Here are just a few. Do you suture lacerations that are a day or too

old or let them heal by secondary intention?

Do you irrigate the laceration before closing it?

If you do, what do you use to irrigate with?

Is tap water good enough?

How sterile do you need to be when repairing lacerations?

Do you need sterile gloves?

Do you need to sterilize the field?

What about the suturing itself? Is averting the edges of the laceration necessary? When do you use staples or sutures or wound closure

strips, commonly known as stare strips, or surgical glue? Then there's what you counsel the patient

to do with the wound after they leave the ED.

What aftercare instructions are evidence-based? Can you get the wound wet? Does allowing the wound

to get wet depend on what closure technique you use? Do wetness restrictions depend on whether

you use glue or sutures or staples. What's the best kind of dressing,

if any dressing at all? Do topical antibiotics reduce the rate of infection, or is it just the petroleum

...