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laceration repair

Help With Laceration Repair

After graduate school, my first practice setting was in an emergency department.  I had always worked in the ED as both a nurse and an EMT.  The emergency department was where I was most comfortable.  Prior to starting in that first practice setting, however, I was asked about my skills portfolio by the recruiter.  I had received a minimal amount of training on laceration repair and incision and drainage in graduate school, and no training on orthopedic nerve blocks, general nerve blocks, biopsy techniques (not that I would truly need that in the emergency department), or ultrasound evaluation of soft-tissue disorders. My ED background supported an ability to work with emergent cases.  But, the central concern was whether I was competent to serve in a critical care area as a clinician / provider.

After the recruiter, supervising physician, and credentialing team reviewed my CV, I was encouraged to take the Emergency Medicine Boot Camp and “some kind of laceration repair course”.

The Emergency Medicine Boot Camp was fantastic and I can’t say enough great things about it.  I entered the boot camp a provider-novice and exited with an array of perception, diagnostic, and assessment tools that brought me to a point where the intense and steep learning curve of being an emergency department clinician was manageable. I was allowed a few months to find a good laceration repair course (the courses on the market at that time seemed to cover only a couple of techniques and didn’t address a lot of questions I had).

Laceration Repair Bottle Neck

After a few months of working in the ED, I realized that my total lengths of stay were increased most, in fact bottle-necking, when suturing / laceration repair was involved.  I did not have enough of an underlying skill-set or speed of practice when it came to this crucial procedure.  I was great at the old standard simple-interrupted technique.  But I was forgetting this or missing that with assessment or consultation.  It was the things I-didn’t-know-that-I-didn’t-know that honestly scared me.  What was I going to miss because of a knowledge gap in the areas of assessment, diagnostics, or procedures that would land me in court or, worse, really harm someone?

So, I took some time (initially two weeks) and began to read about laceration repair. This literature review journey ultimately lasted about a year.  Books like Alexander Trott’s Wounds and Lacerations.  Journal articles such as R. Preece’s (et al.) 2015 publication in Medical Education Online that found 81% of medical students believe they received insufficient laceration repair training in medical school.  And countless Medscape, Epocrates, and NIH / PubMed articles.

A.C.E. F.A.S.T. Closure

I began to see a trend in the literature discussing laceration repair, suturing, and wound care that pointed to some semblance of a method approach. I saw in the literature a formula that I could use every time on every patient that would remind me what to do, when to do it, and why:

  • Cleanse
  • Examine
  • Foreign body consideration
  • Anesthetize
  • Surgical consideration
  • Antibiotic consideration
  • Tetanus consideration
  • Close the wound

Getting through nursing and graduate school consisted of finding neat ways to stuff as much information as I could into mnemonics.  So, I did just that with the method I saw before me in the literature.  I stuffed as much information as I could into the letters C, E, F, A, S, A, T, and C.  After some rearranging, I decided “CAFE SCAT” wouldn’t work, and again rearranged.  As it turns out, A.C.E. F.A.S.T. Closure fit nicely, so I registered this mnemonic, learned how to shoot the best possible digital video, wrote, and then produced a course that would teach this mnemonic.

The Online Suture Course

The end result is Online Suture Course – a 34 module (sounds big but it’s fun), 13 suturing technique course with 3 anesthesia delivery approaches and 10 case studies.  It’s my best effort to positively affect my profession and enhance the training of my colleagues, especially those who work in urgent or primary care, or emergency departments.

If my benchmark question is, “Would I take this course?” then I have met my own benchmark.  I’m a coffee snob, a water snob, and a CME snob.  I nit-pick CME courses to no end, sometimes, if I have a problem with the presentation or the facts presented.  Using my CME snobbery as a standard applied to my benchmark question, I still answer “Yes, I would take this course.”

I encourage you to take the Online Suture Course.  Doing so will enhance your skill-set, expand your marketability, and will help to answer that question of competence when asked by a recruiter, a hospital board or, most importantly, by you about yourself.

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