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 — the wound classes (clean, clean-contaminated, contaminated, dirty-infected) mapped to the mechanism classes (laceration, crush, bite, puncture, avulsion), the structured MEAT assessment (mechanism, examination of neurovascular-tendon-bone-depth-contamination-foreign body, age of wound, type), the irrigation standard (normal saline under 7 to 15 psi pressure via splash-guard syringe, large volume), debridement of devitalised tissue, the tetanus prophylaxis schedule (diphtheria-tetanus-acellular-pertussis vaccine 0.5 mL IM plus tetanus immune globulin 250 IU IM per the ACIP and Australian schedule by wound type and vaccination history), the antibiotic decision (amoxicillin-clavulanate 875/125 mg BD for mammalian bites covering Pasteurella), and the closure decision (primary versus delayed primary versus secondary). ACEM-primary, globally tagged.
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16 MCQs with explanations
Target exams
Red flags
Related topics
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Meet the patient
It is 2am. A 34-year-old gardener has a 6 cm forearm laceration from a metal sheet, sustained four 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]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Emergency Medicine fellowship atlas.
References10Show ledgerHide ledger
- [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