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Cuts, Lacerations & Small Open Wounds
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Treatment for cuts, lacerations and small open wounds

Most small cuts will heal with the following measures:

  • Cleanse w/water under gentle pressure. This is the best way to clean a wound. Either a briskly running faucet or a hand-held shower nozzle is the best way to wash a wound. The wound should be washed for 10-15 minutes. Make sure you remove all dirt and debris. Do not scrub deep wounds or bites, just wash them out. (1) Unless instructed by your physician or health care provider, avoid irrigating wounds that are healing, with: Povidone Iodine, hydrogen peroxide, alcohol, Dakins solution, and all antiseptic agents such as soaps. These solutions are toxic to healthy, regenerating tissue and thus impede wound healing.

  • Stop any bleeding by applying direct pressure to the wound:

    If necessary
    ...

    • Lie down and elevate the site that is bleeding, if possible.
    • Remove any visible objects in the wound that are easy to remove.
    • Remove or cut clothing from around the wound.
    • Remove any jewelry from the general area of the wound so if the area swells, the jewelry will not affect blood flow.
    • Apply steady, direct pressure with a dressing or a cloth for a full 15 minutes. (Tourniquets are generally not helpful If blood soaks through the cloth, apply another one without lifting the first. If there is an object in the wound, apply pressure around the object, not directly over it.(2) If moderate to severe bleeding has not slowed or stopped after 15 minutes, continue direct pressure and elevation of the area that is bleeding, and contact your physician.

  • Keep the wound clean and covered with a clean, dry dressing. Change the dressing everyday. Keep the dressing from becoming saturated with water as it will cause the wound to become macerated and heal more slowly.  Also, wounds that are left open to air will dry out and heal more slowly.

  • Apply Polysporin antibiotic ointment  every day only if the wound was dirty or contaminated. Avoid  Neosporin ointments because they contain neomycin.  Neomycin is a very common allergen--20% of the population is allergic to neomycin which is found in both prescription and many over-the-counter topical antibiotic creams, ointments, lotions, ear drops, and eye drops. (1)  Polysporin is an excellent alternative topical antibiotic cream that does not contain neomycin.
      
 
Tetanus prophylaxis Tetanus (Td) injection should be given within 24 hrs. of a tetanus-prone injury

A tetanus booster is necessary if the patient has not had a tetanus immunization in the last 5 years (for dirty wounds) or in the last 10 years (for clean wounds).  Occasionally both a tetanus booster and tetanus antibodies are required for wounds that are tetanus-prone in a patient with incomplete immunizations.(3)

Tetanus is a life-threatening condition resulting from a poison made by the Clostridium tetani bacterium, which is often present in dirt, dust and animal waste. Common locations for the entry of the bacterial spores are puncture wounds, such as those caused by nails, splinters, or insect bites. However, any break in the skin can provide a potential entrance.
 

Wounds requiring sutures:

Stitches can help to stop bleeding, protect underlying tissues, improve wound healing and minimize scarring.

Deep wounds, or wounds on the face or hands need stitches. A wound that cuts deeply through the skin or is gaping or jagged-edged and has fat or muscle protruding usually requires stitches. As a general rule of thumb, wounds requiring sutures penetrate the subcutaneous tissue and are greater than 1/2" long. Consult your physician or health care provider for guidance, especially if the wound is on the face or hand, or involving a tendon, ligament, nerve, or vessel. Check the range of motion of the limb as well as sensation to touch.

Steri-strips: A strip or two of surgical tape may hold a minor cut together, but if you can't easily close the mouth of the wound, see your doctor as soon as possible.

Wounds should be sutured within 6-8 hours: Proper closure within a few hours minimizes the risk of infection, but wounds should at least be sutured within 6-8 hours (5) from time of injury as risk of infection increases with time. 

Wounds associated with Infection:

Consult your physician or primary care provider if there is:

  • Redness, warmth, or swelling of the skin surrounding the wound, and/or there is
  • Thick exudate (pus or drainage) in the wound, and/or there is a
  • Nonhealing wound and/or there is
  • Fever or chills associated with the wound could be evidence of systemic infection (infection in the blood stream) and medical consultation should be sought immediately.

Wounds from lead graphite (pencil lead)
click here

Wounds that require immediate consultation with a physician or NP, include:
  • Facial wounds or hand wounds.

  • Puncture wounds or penetrating subcutaneous tissue

  • Wounds requiring sutures (penetrate subcutaneous tissue and > 1/2"--general rule)

  • Wounds associated with functional impairment--involving tendon, ligament, nerve,
    or vessel. (check range of motion of the limb as well as sensation)

  • Suspicion of internal organ damage

  • Bleeding not easily brought under control.

  • Wounds from a contaminated object or those that cannot be easily cleaned.

  • Wounds associated with infection (erythema and warmth of skin, purulent exudate)

  • Fever, chills, associated with the wound

References:
  1. Wound Care/Home Care from emedicine.com
  2. Stop the Bleeding from WebMD
  3. Tetanus from emedicine.com  This is a patient education handout about the disease and its symptoms.
  4. Tetanus from emedicine.com. This is an article written for health care providers.  The author is Daniel J Dire, MD, FACEP, FAAEM, Clinical Assistant Professor, Department of Emergency Medicine, University of Texas-Houston
  5. Scrapes from WebMD.com
  6. Seven first-aid standbys you should never use  from ReadersDigest.com


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