EM · Procedural & diagnostic ED skills
Wound assessment and management
Also known as Wound care · Laceration repair · Wound closure · Traumatic wound management · Bite wound management · Tetanus prophylaxis · Wound irrigation
Wound assessment and management in the ED — irrigation with tap water equivalent to saline, infection risk factors (diabetes, contamination, length, leg site, foreign bodies) with time mattering less, tapes and glues matching sutures, bite prophylaxis with amoxicillin-clavulanate first-line plus rabies schedule, puncture admission and bone-scan pathway, and the ACIP tetanus schedule with Td-or-Tdap flexibility.
Checked against its sources on 13 Oct 2026
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Related topics
- Local anaesthesia and topical agents
- Procedural sedation in the emergency department
- Consent, capacity and the medico-legal framework in the emergency department
- Major trauma resuscitation — the team-based systematic approach
- Secondary survey
- Burn management in the emergency department
- Paediatric trauma — the modified approach
- Acute limb ischaemia (the emergency of the 6 Ps)
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Target exams
Red flags
- Explore for tendon, bone and foreign bodies before anaesthesia — foreign body OR 2.6 for infection
- Bite prophylaxis for high-risk bites — amoxicillin-clavulanate first-line; rabies globulin plus days 0/3/7/14
- Puncture infection at 24-36 hours means admission — bone scan if osteomyelitis suspected
- Tetanus: DTaP x5 plus adolescent Tdap, adult Tdap if never had, Td every 10 years
Meet the patient
It is 2am. A gardener has a forearm laceration from a metal sheet sustained hours ago; the edges look clean but the wound base is dirty, and he cannot remember his last tetanus. The registrar turns to you: close it now, or leave it open? [1]
Hold that question. The next ten minutes answer three things — is anything damaged beneath the skin, is the wound clean enough to approximate, and does he need a tetanus booster — and every section below feeds one of those. [1]
References11ShowHide
- [1]Weiss EA, Oldham G, Lin M, Foster E, Quinn JV. Water is a safe and effective alternative to sterile normal saline for wound irrigation prior to suturing: a prospective, double-blind, randomised, controlled clinical trial BMJ Open, 2013.PMID 23325896
- [2]Moscati RM, Mayrose J, Reardon RF, et al. A multicenter comparison of tap water versus sterile saline for wound irrigation Acad Emerg Med, 2007.PMID 17456554
- [3]Hollander JE, Singer AJ, Valentine SM, Shofer FS. Risk factors for infection in patients with traumatic lacerations Acad Emerg Med, 2001.PMID 11435186
- [4]Quinn JV, Polevoi SK, Kohn MA. Traumatic lacerations: what are the risks for infection and has the 'golden period' of laceration care disappeared? Emerg Med J, 2014.PMID 23314208
- [5]Ellis R, Ellis C. Dog and cat bites Am Fam Physician, 2014.PMID 25250997
- [6]Havers FP, Moro PL, Hunter P, Hariri S, Bernstein H. Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2019 MMWR Morb Mortal Wkly Rep, 2020.PMID 31971933
- [7]Yoon Y, Kim H, Kim J, et al. Infection prevention and treatment following dog bites: a systematic review of randomized controlled trials J Trauma Inj, 2025.PMID 40175075
- [8]Elfar A, Ahmed Osman Mohamed A, Mahdi A, et al. Suture Techniques for Traumatic Wound Closure in the Emergency Department: A Systematic Review of Cosmetic, Functional, and Infection-Related Outcomes Cureus, 2025.PMID 40792329
- [9]Liang JL, Tiwari T, Moro P, et al. Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP) MMWR Recomm Rep, 2018.PMID 29702631
- [10]Eidelman M, Bialik V, Miller Y, Kassis I. Plantar puncture wounds in children: analysis of 80 hospitalized patients and late sequelae Isr Med Assoc J, 2003.PMID 14509132
- [11]Griego RD, Rosen T, Orengo IF, et al. Dog, cat, and human bites: a review. Journal of the American Academy of Dermatology, 1995.PMID 7490347