SKIN INJURY (CUTS, SCRAPES, BRUISES)
Cuts and Scratches:
Superficial cuts (scratches) only extend partially through the skin and rarely
become infected. Deep cuts (lacerations) go through the skin (dermis).
Abrasions or Scrapes: An area of superficial skin that has been
scraped off. Commonly occurs on the knees, elbows and palms.
Bruises: Bruises (contusions) result from a direct blow or a
crushing injury; there is bleeding into the skin from damaged blood vessels
without an overlying cut or abrasion.
When are Stitches Needed?
- Any cut
that is split open or gaping probably needs sutures (stitches). Cuts longer
than 1/2 inch (1/4 inch on face) usually need sutures.
- A physician should evaluate any open wound that may need sutures
regardless of the time that has passed since the initial injury.
- Tetanus is a rare
infection caused by bacteria that are found in many places, especially
in dirt and soil. The tetanus bacteria enter through a break in the skin
and then spread through the body.
- Tetanus is commonly called "lock jaw" because the
first symptom is a tightening of the muscles of the face. However, the
final stage of the infection is much more serious. All of the muscles of the
body go into severe spasm, including the muscles that control breathing. Eventually
a person with a tetanus infection loses the ability to breath, and may die in
spite of intensive treatment in the hospital.
- A tetanus booster protects you from getting a tetanus infection.
It does not prevent other kinds of wound infection.
Clean Cuts and Scrapes - Booster Needed Every 10 Years: Patients
with clean MINOR wounds AND who have previously had 3 or more tetanus shots
(full series), need a booster every 10 years. Examples of minor wounds include
a superficial abrasion or a cut sustained while washing dishes. Obtain booster
within 72 hours.
Dirty Cuts and Scrapes - Booster Needed Every 5 Years: Patients
with dirty wounds need a booster every 5 years. Examples of dirty wounds include
those contaminated with soil, feces, saliva and more serious wounds from deep
punctures, crushing, and burns. Obtain booster within 24. When in doubt? assume
that it is a dirty wound.
See More Appropriate Topic (instead of this one) If
WHEN TO CALL YOUR DOCTOR FOR SKIN INJURY
Call 911 Now (you may
need an ambulance) If:
- Major bleeding
(actively bleeding or spurting) that can't be stopped
- Cut on the neck, chest, back, or abdomen that may go deep (e.g.
- First Aid: Apply direct pressure to the entire wound with a
Call Your Doctor Now (night or day) If:
- You think
you have a serious injury
- Severe pain
- Bleeding that hasn't stopped after 10 minutes of direct pressure
- Cut is very deep (e.g. can see bone or tendons)
- Skin is split open or gaping and may need stitches
- Dirt or grime in the wound is not removed after 15 minutes of
- Skin loss from bad scrape goes very deep
- Skin loss involves greater than 10% of body surface (Note: the
hand's surface equals 1%)
- High pressure injection injury (e.g. from paint gun, usually
- Cut or scrape looks infected (redness, red streak or pus)
Call Your Doctor Within 24 Hours (between 9 am
and 4 pm) If:
- You think
you need to be seen
- Several bruises occur without any known injury
- Very large bruise follows a minor injury (wider than 2 inches)
- No tetanus booster in more than 10 years (5 years for dirty
cuts and scrapes)
- Diabetic with any cut or scrape on foot
Call Your Doctor During Weekday Office Hours If:
- You have
other questions or concerns
Self Care at Home If:
- Minor cut,
scrape or bruise and you don't think you need to be seen
HOME CARE ADVICE FOR MINOR CUT,
SCRAPE, OR BRUISE
- Treatment of Minor Cuts,
Scratches and Scrapes (abrasions):
- Apply direct pressure for 10 minutes to stop any bleeding.
- Wash the wound with soap and water for 5 minutes.
- For any dirt, scrub it gently with a washcloth.
- Cut off any pieces of dead loose skin using a fine scissors
(cleaned with rubbing
alcohol before and after use).
- Apply an antibiotic ointment, covered by a Band-Aid or dressing.
Treatment of Minor Bruise:
- Apply a cold pack or an ice bag wrapped in a
towel for 20 minutes
each hour for 4 consecutive hours. (20 minutes of cold followed by
40 minutes of rest for 4 hours in a row).
- 48 hours after the injury, use local heat for 10 minutes 3 times
each day to help
reabsorb the blood.
- Rest the injured part as much as possible for 48 hours.
Pain Medication: For pain relief, take acetaminophen every 4-6 hours
(e.g. Tylenol; adult dosage 650 mg) OR ibuprofen every 6-8 hours (e.g. Advil,
Motrin; adult dosage 400 mg).
- Do not take ibuprofen if you have stomach problems, kidney disease,
are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory
drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
- Do not take acetaminophen if you have liver disease.
- Read the package instructions thoroughly on all medications
that you take.
Expected Course: Pain and swelling usually begin to improve 2 or 3
days after an injury. Swelling is usually gone in 7 days. Pain may take 2 weeks
to completely resolve.
- Call Your Doctor If:
- Looks infected (pus, redness, increasing tenderness)
- Doesn't heal within 10 days
- You become worse or develop any of the "Call Your Doctor"
This information is not intended be a substitute for professional medical
advice. It is provided for educational purposes only. You assume full
responsibility for how you choose to use this information.
Adult HouseCalls Online. Copyright © 2000-2004
David Thompson, M.D. FACEP
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