Working in the emergency department is sometimes referred to as “walking in a minefield with clown shoes on.” The older I get, I see it more and more.
As there are common things that can resemble more serious illness, the simple laceration can also hide more serious underlying problems. It is important to be familiar with the basic anatomy, physical exam, and when to order radiology studies so that you don’t miss injuries that will cause your patient problems down the road, as well as land you in a lawsuit.
I found it surprising that the reason physicians get sued when it comes to lacerations is NOT because of cosmetic outcome. It is because a missed fracture, nerve or tendon injury that leads to loss of function. That is why you have to do a thorough nerve and musculoskeletal exam with full range of motion with potentially injured joints. Check sensation. Look for subtle fractures and foreign bodies. Also-make sure to get the plain film BEFORE you sew in the foreign body… Do the exam, order the x-ray and document well. If its not in the chart it didn’t happen.
Sincerely,
Dr. Patrick O’Malley
The Laceration Course, Course Director
