The efficacy of cyanoacrylate-derived surgical adhesive for use in the repair of lacerations during competitive athletics

Octylcyanoacrylate (Dermabond) is approved by the Food and Drug Administration for laceration closure. International studies have shown its utility in wound closure and have shown it to be as good or better than suture closure for speed, patient preference, and cosmesis, with no difference in the rate of dehiscence or infection. We sought to determine whether it retains its tensile strength, durability, and skin apposition when an athlete is allowed to reenter competition, where it is subject to recurrent stress, moisture, and trauma. The study was performed at two professional hockey sites. Wounds were anesthetized, irrigated, and debrided. The skin was closed with Dermabond. The athlete was returned immediately to competition. Wounds were examined at the end of competition and again at 7 days. A total of 32 lacerations on 28 players were studied. The mean size of laceration was 2.3 cm (range 0.8 cm to 4.5 cm). The majority (95%) of wounds were on the face. Of the 32 lacerations, 31 (97.6%) had good results at the conclusion of the game. Of these 31, all had good results at 7 days following repair. Dermabond retained its strength, durability, and skin apposition when the athlete was allowed to reenter competition following wound repair.

Pediatric analgesia and sedation

Sedation and analgesia are essential components of the ED management of pediatric patients. Used appropriately, there are a number of medications and techniques that can be used safely in the emergency care of infants and children. Emergency physicians should be competent in the use of multiple sedatives and analgesics. Adequate equipment and monitoring, staff training, discharge instructions and continuous quality management should be an integral part of the ED use of these agents.

A statewide evaluation of pediatric prehospital and hospital emergency services

OBJECTIVE

To evaluate the extent of pediatric emergency training and the availability of pediatric equipment and patient care protocols in the prehospital and hospital settings.

DESIGN

Statewide surveys developed by the North Carolina Provisional Committee on Pediatric Emergency Medical Services and by the Office of Emergency Medical Services.

SETTING AND PARTICIPANTS

Surveys were mailed to all 572 prehospital Emergency Medical Service (EMS) agencies and separately to all 125 acute-care hospitals in North Carolina.

INTERVENTIONS

None.

MEASUREMENTS/MAIN RESULTS

Surveys were returned by 335 (58.6%) of the prehospital providers, including all 45 paramedic and 14 advanced-intermediate provider agencies. One hundred (80%) of the acute-care hospitals returned surveys. Only 10.8% of the prehospital EMS agencies provided more than 10 hours of basic training in pediatric emergency care; 18% provided more than 5 hours of continuing education in pediatric emergencies over a 3-year period. Pediatric-specific equipment was available in many prehospital vehicles, although some deficiencies were noted. Written pediatric management, bypass, and helicopter transport protocols were absent in most prehospital programs. Paramedic programs generally were much better in all areas, although deficiencies were present. Only 14% of the responding hospitals had more than 20 pediatric beds; 13% reported seeing more than 100 patients per day in the emergency department. Deficiencies were identified in pediatric patient care protocols, triage and transport agreements, pediatric training of nurses and physicians, and equipment. Equipment deficiencies were more marked in the intensive care units than in the emergency departments.

CONCLUSIONS

These survey data are inexpensive to obtain and demonstrate EMS system deficiencies. The survey information provides a baseline measurement that can lead to measurable, targeted changes in the state's EMS system for children.

Pediatric trauma

Injured children require an organized, properly equipped, team approach to management. The emergency physician must be aware of the anatomic and physiologic differences that predispose the child to certain injuries. Aggressive airway and hemodynamic resuscitation are essential in the critically injured child. A network of pediatric trauma consultants should be identified in your region for early consultation and referral. Continued research and the ongoing epidemiologic studies from the National Pediatric Trauma Registry will improve our understanding and management of the injured child. It is essential for each of us to become a strong injury prevention advocate in our own community.