Simple laceration repair and wound management — branching viva

Branching viva — simple laceration repair and wound management

The examiner releases the stem and then branches into five probes. A strong candidate answers the assessment first, defends the analgesia, chooses the closure method with justification, recites the local anaesthetic doses, and then adapts when the scenario turns to a bite. [1] [8]

Opening (examiner)

"A previously well four-year-old falls against a table edge and splits the skin over her chin. The laceration is clean, three centimetres long, superficial, and the edges oppose easily. She is frightened but cooperative. Walk me through your management." [1]

Branch 1 — Assessment (expected answer)

Use the MADNESS structure: mechanism (blunt table edge), age of wound, depth and distal neurovascular function, non-accidental-injury check, examine tendon and joint, site and tension, safeguarding and tetanus status. For a face wound, assess the lip vermillion border, facial nerve function, and distal sensation before any anaesthesia, because local anaesthesia masks nerve injury. Take a targeted history including oral intake, immunisation, allergies, and bleeding disorder. [1]

Probe. "She has not eaten for three hours — does that matter?" — Yes, it is relevant if procedural sedation becomes necessary, so document fasting status at the outset even if sedation is not the plan. [2]

Branch 2 — Analgesia (expected answer)

The default first step is topical LET gel (lidocaine four percent, epinephrine one in two thousand, tetracaine half percent) applied into the wound under an occlusive dressing for twenty to thirty minutes, with distraction and comfort positioning. LET anaesthetises the dermis by sodium-channel blockade and makes even subsequent infiltration painless. For the child who remains distressed, layer in non-pharmacological measures and consider procedural sedation for a long or complex repair in a monitored setting. [4] [2]