sinaiem.org

Dr. Hoxhaj gave a great presentation at the beginning of my intern year, on some of the top papers in emergency medicine published this . His criteria for excellence? They were either landmark works that changed EM practice, or well-conducted research with surprising conclusions that challenged dogma and made us think. Or, as he said, he's just messing with us.

Over the next few weeks, I'll post some of these papers here, as blog entries. Each post will have a link to the papers mentioned, plus some of his commentary gleaned from his slides. Feel free to add your own comments (especially if you're Dr. Hoxhaj).

The first papers I wanted to mention involve wound care — specifically, some novel, and maybe cavalier, ways of treating lacerations.

• Perelman asked if sterile gloves were even necessary, in a prospective randomized trial of over 800 adults with simple lacs. Patients were excluded if they were immunocompromised, had diabetes, liver disease, keloids, or were taking / starting antibiotics. They found no significant difference in infection rates. Interesting tidbit: Sterile gloves cose $0.70 a pair, compared to $0.10 a pair for boxed gloves. In an ED with 10 uncomplicated lacs per day, going onsterile would save $2000 a year — enough for plenty of free lunches. Time is valuable, too.

• Valente at Jacobi looked at wound irrigation in simple lacerations (pediatric population, aged 1-17). He compared tap water coming from a faucet, to sterile saline pushed through an 18-guage syringe with splash guard. It was a large, prospective trial. The New York CIty tap water was also cultured, yielding trivial contaminants. The patients had equal contamination rates (2.9%) regardless of irrigation method, though kids got more infected foot lacs with the tap water, but it's hard to say that was significant. Fascinating discussion.

• Dr. Hoxhaj cited another paper, about using "hair apposition" instead of sutures to close scalp lacs (ie, just tying the wound closed with the patient's own hair). It caused less pain, was faster, and looked better, according to this randomized trial – the HAT study, by Hock et al. Has anyone tried this?

Posted on Monday, June 19th, 2006 at 7:22 pm by Nick. Filed under Wound Care, Journal Club.
You may post a comment.