By Dr. Harold Adams
It’s a Saturday morning and you’re doing work around the yard. But, whoops, you’re working too quickly and now you’ve cut your finger! Blood is gushing, your finger is now throbbing, and you’re wondering if you need stitches. What should you do?
Besides causing pain, cuts and abrasions can range from superficial to serious. While many can be cared for at home, others need medical attention. It’s important to know the difference so that you can get the care you need and maintain those anxiety levels.
Is there blood everywhere? First, try to get that under control. Assuming you are not dealing with a significant pulsating artery, the bleeding from a typical wound will stop with gentle pressure and elevation. So grab the cleanest material available, apply pressure, lie down if necessary, and get the injured body part up in the air. Give it several minutes of consistent pressure.
For some of us on aspirin, other blood thinners, or those with a clotting disorder, it will take a bit longer. Generally, the amount of blood loss isn’t significant. If we get lightheaded, it is usually because the appearance of blood can be frightening. However, good healing requires a good blood supply, so knowing your blood can get to the wound is a good thing!
Next comes cleaning the wound – ouch again. It might not be too important if you cut your hand washing dishes, but for those outdoors injuries, getting out any foreign material greatly reduces the likelihood of a wound becoming infected. Cleaning is usually accompanied by re-bleeding, so if the amount of bleeding was a concern, cleaning can wait until you get care.
Cleaning can be done with a stream of tap water, trying to get all visible debris out of the wound. Peroxide is often used but isn’t recommended. Peroxide may be a potent antiseptic and cleaner, but it has the potential to be toxic to your cells, and we want them healthy to heal the wound. Soaking doesn’t help much either. Gentle abrasion may be needed. If we see a particularly contaminated or tattooed wound at MediQuick, we use a pressured jet of water or, with a numbing agent, a more vigorous scrub with a soap safe for wounds.
You will likely need medical care if the wound is deep through the skin into the underlying tissue. In my practice, we use stitches, staples, tape or glue to close the wound edges. The longer a wound is open, the more at risk it may be to slow healing, so wounds are best repaired within hours of an injury – not the next day. If you think your wound needs medical attention, cover it with a clean, moist cloth, apply gentle pressure, and be en route to the doctor. Many adults may need a tetanus vaccination.
For the abrasions and shallow wounds you can manage at home, you will find more than band aids on the pharmacy shelf these days. Skin adhesive (glue), tapes, transparent film and thick opaque hydrocolloid/gel bandages are available. Your minor wound will likely do well with whichever product you choose.
The newer dressings come from lessons learned caring for difficult chronic wounds. It was observed that wounds that remained moist healed faster than those that were left open to air and became dry. The enzymes and proteins in the fluid your body expresses onto wounds nurture healing, so keeping them in contact with the wound is advantageous.
You can keep a wound moist with an antibiotic ointment such as bacitracin or with petroleum. Be sure to use band aids or traditional dressings. Then the wound is cleaned gently a couple of times a day and ointment reapplied. Prefer something more natural? Aloe vera and some honey products are great options as well.
Another alternative is to cover the wound with one of the newer dressings such as transparent film and hydrocolloids/gels. They keep the good proteins in and the bacteria out. They work well for abrasions and small burns. The thin transparent film dressings can cover a clean abrasion for many days. This is done safely as you can monitor the wound through the dressing and remove it if the wound appears inflamed or excessive fluid builds up.
The thicker opaque dressings don’t allow viewing of the wound so they should not be left on as long. They have the capability to absorb excess fluid into the substance of the dressing. They work well on blisters as they also neutralize the shearing forces that cause blisters. They are tougher and good for areas of the body like the hands and feet that might see contact.
Be safe, and take good care of your wounds.
Dr. Harold Adams is an emergency medicine specialist with Hartford HealthCare.
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