A 6-year-old girl presents with a deep burn to the lower lip. Her mom found her crying next an electrical outlet. There was a vacuum cleaner plugged in with teeth marks noted on the power cord. She had significant bleeding at home that resolved after 10 minutes of direct pressure. What is the next most appropriate step in management?

A. Admit to observe the patient for 24 hours. 

B. Admit to a telemetry bed. 

C. Suture the burn.

D. Observe for 8 hours in the Emergency Department and discharge with a prescription for antibiotics and plastic surgery follow up if patient does not deterioate. 

E. Discharge the patient to home with plastic surgery follow up in 1 to 2 days

Answer: E

-The above vignette is addressing the management of an oral commissure burn from chewing on a power cord; these injuries create significant necrosis and edema.

-The most appropriate next step involves plastic surgery consultation or outpatient follow up for evaluation for debridement and reconstructive surgery planning.

-There is also concern for labial artery injury when the eschar sloughs off, leading to delayed hemorrhage, usually occurring around 5 days after injury. 

-Labial artery injury can lead to hemorrhagic shock. 

-Provide detailed instructions to parents regarding pinching inner and outer cheek together to apply direct pressure for bleeding and immediate return to ED. 

-PO challenge the patient prior to discharge to ensure the patient can tolerate food, liquids and pain medications.