Trick of the trade: Irrigating scalp lacerations

Thanks to my new-found Emergency Medicine friend in Turkey, Dr. John Fowler has some useful tips about scalp lacerations.

Often patients with scalp lacerations have clotted blood in their hair. While we can irrigate the wound itself (and unavoidably soaking the patient in cold irrigation fluid), a lot of blood remains stuck in their hair. It would be nice if we could completely wash out the blood. This would further allows us to detect occult scalp lacerations.

Photo courtesy of Dr. John Fowler

Trick of the Trade #1:
Position head in sink with pullout faucet head.

Based on the hairdresser sink idea, have the patient either sit in a chair or lay in a gurney with his/her head beyond the edge. If seated, the patient should extend his/her neck into the sink. Wash out all the blood in the hair and then irrigate the scalp laceration in the sink.

If in a gurney, the patient can be placed in a little Trendelenburg position with the head resting in the sink, to ensure that the fluids run into the sink (instead of down the patient's back).

Wash out the blood using the pullout faucet head. If this unavailable, consider using saline bottles with multiple holes on the top, created by 18 gauge needles, to bulk irrigate. See prior irrigation trick.

Trick of the Trade #2:
Make a "sink" using a plastic basin.

Since I am oftentimes irrigating patients still in cervical spine immobilization, I can't extend their neck into a sink. So I bring the "sink" to them. I cut out a partial opening in a plastic basin and place the patient's head in the basin. This basin collects the irrigation fluid. If the fluid overflows, use a Yankauer to suction the fluid away. Irrigate using the saline bottle technique explained above.