When should I go to the Emergency Department (ED) after sustaining a laceration?

When to Go to the Emergency Department After a Cut

You should go to the Emergency Department (ED) for a laceration if it is deep, gaping, continues to bleed despite direct pressure for 15 minutes, involves sensitive areas like the face or genitals, or if there are signs of infection or impaired function.

Assessment of Laceration Severity

When evaluating whether a cut requires emergency care, consider these factors:

Immediate ED Visit Required:

• Uncontrolled bleeding: Bleeding that continues despite applying direct pressure for 15 minutes
• Deep wounds: Cuts that expose fat, muscle, bone, or other deeper structures
• Location concerns:
  • Facial wounds (especially near eyes, lips, or across cosmetic lines)
  • Wounds over joints
  • Genital injuries
  • Mouth lacerations that go through the lip or affect function 1
• Functional impairment: Inability to move a body part normally or numbness/tingling
• Foreign body: Visible or suspected debris embedded in the wound
• Animal or human bites: These have high infection risk
• Signs of infection: Redness extending beyond wound edges, warmth, pus, or fever
• Tetanus risk: Dirty wounds if tetanus immunization is not up to date

Wounds That Can Be Managed at Home:

• Superficial cuts (only involving epidermis)
• Small cuts (less than 1-2 cm) with well-approximated edges
• Minimal bleeding that stops with brief direct pressure
• No functional impairment
• Clean wounds with minimal contamination

Time Considerations

The traditional "golden period" for wound closure has been challenged by recent evidence. While earlier treatment is generally better, many wounds can be safely closed even after several hours:

• Clean wounds: May be safely closed up to 18 hours after injury 2
• Facial wounds: Higher priority due to cosmetic concerns and good blood supply
• Contaminated wounds: Require thorough cleaning regardless of time since injury

Home Care for Minor Cuts

For minor cuts that don't require ED care:

1. Clean with potable tap water (as effective as sterile saline) 2
2. Apply direct pressure to stop bleeding
3. Consider topical skin adhesives for small, low-tension wounds 3
4. Apply an occlusive or semi-occlusive dressing to promote moist healing 2
5. Monitor for signs of infection

Special Considerations

Children

For children with lacerations, the ED can provide specialized pain management including:

• Topical anesthetics like LET (lidocaine, epinephrine, tetracaine) for open wounds 1
• Buffered lidocaine for almost painless injection when needed 1
• For infants under 6 months, sucrose solution can help reduce procedural pain 1

Mouth Lacerations

Injuries to the mouth often require specialized care due to:

• Risk of functional impairment
• Cosmetic concerns with lip lacerations
• Higher risk of infection in some oral wounds 4

Benefits of ED Care for Appropriate Lacerations

When indicated, ED care offers significant advantages:

• Proper wound cleaning and exploration
• Professional closure techniques (sutures, staples, or tissue adhesives)
• Appropriate pain management
• Tetanus prophylaxis when needed
• Specialized care for complex wounds

Remember that while death from cutting injuries is uncommon, proper treatment is essential to prevent infection, minimize scarring, and preserve function 5. Using appropriate wound care products like liquid adhesive bandages can promote healing for minor cuts 6, but more significant injuries require professional evaluation and treatment.