Hemostasis and wound prep
›Hemostasis and wound prep
›Direct pressure for 10 to 15 minutes without peeking
›Topical tranexamic acid 500 mg in 5 mL soaked gauze for mucosal bleeding local protocol dependent
›Irrigation volume targets
›At least 50 to 100 mL per cm laceration length as practical
›Remove devitalized tissue selectively
›Avoid aggressive debridement on face due to cosmetic risk
›Foreign body management
›Plain radiograph for radiopaque foreign body suspicion
›Ultrasound for superficial radiolucent foreign body suspicion
›Avoid blind probing near eye and major vessels
›Closure strategy
›Timing
›Primary closure typical within 24 hours on face if well cleaned
›Delayed primary closure if gross contamination or high infection risk
›Layered closure for deep wounds
›Deep absorbable suture for dead space reduction
›Skin closure options
›5-0 or 6-0 nylon for facial skin typical
›Fast absorbing gut for low tension pediatric facial wounds local protocol dependent
›Vermilion border alignment priority
›First stitch at vermilion border with 6-0 nylon typical
›Lip through and through closure in layers
›Mucosa absorbable
›Muscle absorbable
›Skin nonabsorbable or fast absorbable based on follow up
›Antibiotics prophylaxis
›Indications
›Bite wounds
›Through and through lip laceration with oral contamination
›Grossly contaminated wounds
›Open fractures
›Amoxicillin clavulanate PO 875 mg 125 mg twice daily
›Duration 3 to 5 days prophylaxis typical local protocol dependent
›Penicillin allergy option
›Doxycycline PO 100 mg twice daily plus metronidazole PO 500 mg twice daily local protocol dependent
›Avoid doxycycline in pregnancy and young children local protocol dependent
›Tetanus and rabies
›Tetanus update based on immunization status and wound type local protocol dependent
›Human bite bloodborne exposure counseling and prophylaxis local protocol dependent
›Animal bite rabies risk assessment local protocol dependent
Dental trauma immediate management
›Dental trauma immediate management
›Avulsed permanent tooth reimplantation as soon as possible if feasible
›Do not reimplant primary tooth
›Handling
›Touch crown only
›Avoid touching root
›Cleaning
›Gentle rinse with saline if dirty
›Avoid scrubbing
›Storage media if not reimplanted
›Milk
›HBSS if available
›Saline
›Buccal vestibule if cooperative and low aspiration risk
›Splinting needs urgent dental or OMFS follow up
›Systemic antibiotics for avulsed permanent tooth local protocol dependent
Dental fracture and luxation management
›Dental fracture and luxation management
›Enamel dentin fracture cover exposed dentin with temporary dental dressing if available
›Pulp exposure urgent dental management within 24 hours
›Luxation and subluxation soft diet and dental follow up within 24 hours
›Suspected alveolar fracture urgent OMFS or dental evaluation
›Reassessment loop
›Repeat bleeding check after hemostasis steps
›Repeat neuro exam after analgesia and before discharge
›Repeat eye exam if pain or vision complaints change
›Wound perfusion reassessment after closure