Suture to laceration

otiscokat · Jan 2, 2009

One year ago I put a wood chisle through 2 of my finger tips. After I cried, :yeah: I talked to myself for a while, then had my DH (also a nurse) look at it, then decided I had to go to the imediate care center. I was two hours getting there. They soaked it and sutured it. No one said anything about a time frame. It may be that hospital policy, but not a policy everwhere. It could also have to do with the tpye of injury. I hope your son heals well.

morte, LPN, LVN · Jan 2, 2009

in the deep recess of my mind....lol....i thought it was 6 hours.....1 hour seems quite limited, how many lacerations would even be seen within 1 hour?

Pawz_Beakz · Jan 2, 2009

1 our doesn't even make sense. We don't have a set time in our ER. As another person said, how many people can actually get to the ER in an hour?? Laziness sounds like.

hollie91999 · Jan 2, 2009

I used to work in Pediatrics urgent care and the pediatricians there would do sutures if it was within a 24 hour period. Sounds to me like it was laziness.

Lacie, BSN, RN · Jan 2, 2009

Thank you all for your responses. Yes it is a very deep uneven laceration. As you know a car door can impose significant damage. I changed the dressing this morning and I am actually angered by what I seen. I thought maybe they were busy or something but then he let me know he was the only patient in the er at the time. Grrrr. It is deep and I know from my experiences it would have been sutured. Now it's probably too late. I'm hoping he didnt suffer any nerve damage in it also as I did from the same type injury. He is supposed to return for follow up tomarrow but I may just have him wait till Monday for our regular doctor.

PedsED-RN · Jan 2, 2009

Yeah, that sounds a little weird. I don't think we have a set time frame, it more depends on the individual situation, and how the wound looks at the time of presentation to us. I remember once we had a kid with a pretty bad knee lac from the day before. I want to say he did go to an Urgent Care, or maybe just called them, I can't recall. I can't remember specifics, but I think even though it was close to 24 hrs after, we did repair it, as it had been bleeding pretty much the whole time, an had not really started to consolidate much new tissue.

Sorry he received such poor care, that is disappointing. Getting slammed like that, did they at least x-ray it to make sure that the bones were intact, so he doesn't have crushed fingers on top of a poorly treated gash?

wooh, BSN, RN · Jan 2, 2009

I've shown up at the ER really quick, got seen quick, but it was with a dog bite. Didn't matter how bad the cut was, they didn't want to stitch it up due it being a dog bite and on my hand. (Double infection risk.) It was some nasty gashes, but they healed ok.

Pepperlady · Jan 3, 2009

Thank you all for your responses. Yes it is a very deep uneven laceration. As you know a car door can impose significant damage. I changed the dressing this morning and I am actually angered by what I seen. I thought maybe they were busy or something but then he let me know he was the only patient in the er at the time. Grrrr. It is deep and I know from my experiences it would have been sutured. Now it's probably too late. I'm hoping he didnt suffer any nerve damage in it also as I did from the same type injury. He is supposed to return for follow up tomarrow but I may just have him wait till Monday for our regular doctor.

While he may not have recieved the treatment you expected or he deserved, I wouldn't make it worse by then waiting follow-up til Monday which may also have a negative impact on the healing.

I can't speak for your experience, I do know that for the most part we have a 6 hour time limit in our ER, its also dependent on various ERPs experience, the nature of the wound (such as the dog bite mentioned) its location and what not. What one doctor will not suture after 6 hours one will suture up to 24 hours.

vampiregirl, BSN, RN · Jan 3, 2009

I've shown up at the ER really quick, got seen quick, but it was with a dog bite. Didn't matter how bad the cut was, they didn't want to stitch it up due it being a dog bite and on my hand. (Double infection risk.) It was some nasty gashes, but they healed ok.

Ran into the same situation years ago, except mine was a human bite (I was a group home manager at the time). I prompty sought treatment, but due to the infection risk it couldn't be sutured. I was given antibiotics and provided with very thorough instructions on the care for it. I have a scar, but I'm ok with it.

If the circumstances had been similar to the OP though, I would have been very frustrated. I have very little patience for laziness. I truly hope that this was not the case, that there was another rationale for the care that was provided. Hopefully your family dr. will have some insight for you.

I_LOVE_TRAUMA, RN · Jan 3, 2009

I'm sorry for what your son went through. Sometimes our er is so full with criticals that many not immediately life threatenting (not bleeding profusely) lacs do not get sutured until the morning. Sometimes it is not done until several hours after they are moved to the floor, and sometimes plastics is called and it is again several hours until they are sutured. If the lac requires the OR it may also be several hours before it is repaired. Even very large lacs that are not actively bleeding rapidly may be put on hold until other tests are done or other injuries are treated. Having said that, there may have been good reason why the area was not stitched, I would need more info before I could make a determination as to whether or not the right decision was made. There are certain situations where we leave wounds/lacs open to heal. Your story made me hurt! I agree that there should have probably been an x-ray done to check for any loose bone fragments, even though we don't normally do anything for broken digits.

RNrural · Jan 3, 2009

Living in a rural area prevents the patients from getting to an ER very quickly. Although many farmers in this area will use duct tape on lacerations and finish the job they are working on prior to coming to the hospital :nono: ! Our Doc's use the 6 hour rule in the decision to suture or not.