June 2015 Health Notes

Published 8:02 am Tuesday, June 2, 2015

by Ellen S. Mullen M.D.

Summer is here and the kids are out of school; this means no school nurse to care for their cuts, scrapes and bruises.  The question arises, when do they need to be brought to the doctor or emergency room and when can kids’ injuries be cared for at home?  Not every injury requires a professional evaluation.  Some of the most common wounds include lacerations, abrasions, and bruises.  How can these wounds be differentiated from more serious injuries?  A few simple rules apply.  

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In evaluating a laceration it is first important to control bleeding by holding continuous pressure over the wound.  Once bleeding has been minimized, it is important to clean and evaluate the wound.  Studies show that tap water is as effective as sterile water in irrigating a wound and may even be better since more water is usually used.  Puncture wounds do best with soaking in water allowing the water to penetrate the wound.  Next, evaluate the depth and width of a laceration.  If the wound extends into the underlying subcutaneous fat it will most likely need stitches.  Whether the wound edges are jagged or easily approximated also helps to determine if sutures are needed.  Lacerations where bleeding cannot be controlled or extend into a joint need professional care.  A clean wound, such as cutting oneself on a piece of glass in the sink, requires a tetanus to be updated if it has been more than 10 years since the previous tetanus. A dirty wound, such as stepping on a nail outside, requires a tetanus to be updated if it has been more than 5 years since the last one. Tetanus boosters should be given within 72 hours of the injury.  It is advisable, if sutures are needed, to have them placed within 6-12 hours of the injury to minimize infection.  Bite wounds are typically left open secondary to the high risk of infection unless they are on the face and/or may be disfiguring.  Bite wounds may require antibiotics.  Wounds in general should be kept covered.

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Abrasions must be thoroughly cleansed.  If the scrape will require deep cleansing or debridement or if it extends over joints or large areas a physician should assess the wound.  Otherwise small scrapes can be managed by irrigating with warm tap water and assuring that all foreign bodies have been removed.  Bumps and bruises are treated best with ice to minimize swelling.   Erythematous or pustular wounds require evaluation.  Keeping wounds clean and free of infection is the goal.