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Immediate priorities
Immediate stabilization
If airway compromise from facial trauma, initiate airway management
Blood and vomitus suction readiness
Early difficult airway team activation for massive facial bleeding
If uncontrolled hemorrhage, direct pressure and hemostatic measures
Scalp and face pressure dressing
If arterial spurting, clamp avoidance and urgent specialist consult
If altered mental status or high-energy mechanism, trauma protocol activation
Cervical spine precautions until cleared
Concussion and intracranial hemorrhage screening pathway
Early red flags
If periorbital laceration with vision change, emergent ophthalmology pathway
Globe rupture exclusion before eyelid manipulation
Orbital compartment syndrome screening
If through-and-through cheek laceration, parotid duct and buccal branch injury concern
ENT or plastics consultation trigger
Intraoral exam escalation
If lip laceration crossing vermilion border, cosmetic alignment critical
Specialist repair consideration for complex wounds
Time-sensitive meticulous closure
Hemodynamic and pain targets
Physiologic targets
Adequate perfusion and mental status baseline
If syncope or pallor, evaluate occult blood loss and head injury
If on anticoagulants, lower threshold for imaging and observation
Pain control sufficient to permit irrigation and layered repair
Regional anesthesia preference for large facial wounds
Procedural sedation pathway if required for cooperation
Contamination control and timing
Wound timing and contamination framework
Primary closure favored for most facial lacerations due to high vascularity (ACEP Level C)
Delayed primary closure consideration for heavily contaminated wounds
Bite wounds individualized by location and infection risk (ACEP Level C)
Early irrigation and foreign body removal priority
If glass or gravel suspected, imaging pathway for retained foreign body
Tattooing risk from asphalt and dirt, early debridement consideration
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.