~te scrub ( B e t a d i n e ) f o l l o w e d by b a n d a g i n g w i t h a sterile 4 x 4 gauze pad. The nurses do not w e a r m a s k s ~,hile p r e p p i n g l a c e r a t i o n s . A t N o r t h w e s t C o m m u n i t y 14ospital, the prep of simple l a c e r a t i o n s is also a s t a n d a r d ~ursing procedure. There, a scrub (Betadine) is followed bY a 3 to 5 m i n u t e soak in a n antiseptic solution (Betadine) and t h e n t h e application of a sterile dressing. The nurses also do not w e a r m a s k s while p r e p p i n g lacerationS. In this s t u d y I wore a surgical m a s k while r e p a i r i n g alternate lacerations. E a c h l a c e r a t i o n was draped, u s i n g sterile t e c h n i q u e , w i t h e i t h e r fabric towels (EvanstoP Hospital) or disposable p a p e r d r a p e s (Northwest Community Hospital). Sterile surgical gloves were worn at all times. S u t u r e m a t e r i a l s of 4-0 or 5-0 nylon w i t h a p-1 or p-3 swadged-on needle was used exclusively. At no t i m e were subcutaneous s u t u r e s of any sort used. Dressings u s u a l l y consisted of Adaptic and either K l i n g or Tubegauze on e x t r e m i t i e s and Adaptic a n d 4 x 4's on trunk and facial lacerations. Some facial lacerations were left open w i t h o u t a dressing. The p a t i e n t s were advised to change the d r e s s i n g s a n d to clean t h e i r wounds g e n t l y with hydrogen peroxide daily. They were also i n s t r u c t e d to contact t h e i r own physician, or were referred to a staff physician, for s u t u r e r e m o v a l and follow-up care if a n y complications developed. A total of 92 l a c e r a t i o n s was r e p a i r e d (Table); t h i r t y nine at N o r t h w e s t C o m m u n i t y H o s p i t a l a n d 52 a t Evanston H o s p i t a l . F o r t y - e i g h t were r e p a i r e d w h i l e I wore a surgical m a s k a n d 44 without. Of the 92 lacera-

Without Mask

Healed Infected Healed Infected Total

Northwest Community Hospital

20

1

18

0

39

Evanston Hospital

27

0

26

0

53

TOTAL

47

1

44

0

92

J•PApril

1976

The follow-up d a t a was compiled by m a k i n g telephone calls to each patient, or p a t i e n t ' s parent, t e n to eighteen days after the t i m e of s u t u r i n g . The s t a t u s of each laceration, swelling, weeping, d r a i n a g e of any type Or e r y t h e m a was noted. If a n y antibiotic was used, it was d e t e r m i n e d at this time. W i t h t h e e x c e p t i o n of t h e one case m e n t i o n e d , no w o u n d infections were reported. Therefore, t h e r e was no difference in the r a t e of wound infections of simple lacerations when r e p a i r e d with or w i t h o u t a surgical mask. I concluded t h a t it is not n e c e s s a r y to w e a r a surgical m a s k while r e p a i r i n g simple l a c e r a t i o n s in the e m e r g e n c y department.

John E. Caliendo, MD Miami, Florida

Emergency Department Techniques To the Editor." Most p h y s i c i a n s in e m e r g e n c y practice h a v e developed idiosyncratic techniques t h a t m a k e t r e a t m e n t easier on the p a t i e n t and themselves. H e r e are two "pearls from the pit" I would like to share. A solution of 4% topical xylocaine on a cotton swab or s p o n g e a p p l i e d d i r e c t l y to t h e o p e n w o u n d p r i o r to xylocaine i n f i l t r a t i o n m a y s h a r p l y reduce t h e i n i t i a l p a i n of the needle insertion.

Table L A C E R A T I O N S SUTURED With Mask

tions repaired, only one infection was r e p o r t e d - - one I r e p a i r e d at N o r t h w e s t C o m m u n i t y Hospital while wearing a mask. It was a dog bite to the nose of a four-yearold boy t h a t resulted in a one inch i r r e g u l a r laceration to the left n a s a l ala. The p e d i a t r i c i a n following t h e case p r e s c r i b e d a n t i b i o t i c t h e r a p y 36 h o u r s l a t e r a n d t h e wound was completely h e a l e d in t e n days.

F r e q u e n t l y , d u e to p h y s i c i a n s ' s c h e d u l i n g i n t h e e m e r g e n c y d e p a r t m e n t , one p h y s i c i a n m a y place a small d r a i n in a w o u n d and a n o t h e r remove it. Two procedures m a y help t h e second p h y s i c i a n in p r o v i d i n g follow-up care. First, leave long, visible ends on the s u t u r e s t h a t hold the d r a i n in place. Second, i l l u s t r a t e same on the e m e r g e n c y d e p a r t m e n t record.

J i m Simon, MD Tiburon, California

V o l u m e 5 N u m b e r 4 Page 279