Doc Talk: Treating Cuts and Lacerations

By Alan L. Nager, M.D., M.H.A.

treating cuts

IMAGE COURTESY OF KDSHUTTERMAN AT FREEDIGITALPHOTOS.NET

You probably call them “cuts,” but I call them “lacerations,” even at home. Most doctors do.

Whatever you call them, properly treating cuts is important. If a laceration has significant bleeding or is obviously serious, immediately apply direct pressure with a clean cloth or towel and go to the emergency department or call 9-1-1.

If the injury looks like something you might be able to treat at home, first wash it under warm-to-tepid water for at least two minutes (timed with a watch, clock or timer). Tap water is absolutely fine. Don’t use soap or any other substance. Turn on a good, strong light, or have someone hold a flashlight beam on the area so you can see what you’re doing. Do not worry about the bleeding at this point. It will help rinse the bacteria out.

Next, dry the area and apply direct pressure for 3-5 minutes with a clean cloth or towel to stop the bleeding. Then apply antibiotic ointment or Vaseline and a bandage.

Keep the wound covered for approximately 48-72 hours, removing the bandage three times a day to wash the wound for two minutes with warm, soapy water and re-apply ointment.

Stepping on a nail while wearing tennis shoes is a special case. Bacteria living in the glue in the sole of the shoe can be pushed into the foot by the nail and put your child at risk of serious infection. Even if it looks like just a small puncture wound, this is one of those instances where you need to seek medical care.

Your child also needs medical attention if:

  • You think there is glass, metal, wood or dirt in the laceration;
  • Bleeding continues even after 3-5 minutes of direct pressure;
  • The laceration has open edges that look spread apart (like a tear in fabric); or
  • Your child has a laceration on the face, where scarring can be more important.

If you think your child’s laceration might need to be repaired by a physician, don’t delay. We rarely repair anything more than 8-10 hours after the injury, because that may increase the risk of a wound infection as bacteria can get trapped in a closed wound.

Once the laceration can go uncovered, keep applying antibacterial ointment two to three times a day until it is healed. If your child develops increasing pain or fever, or if there is pus or redness around the wound, seek medical attention.

If your child has a dirty wound and hasn’t had a tetanus vaccine within five years, he or she will need one within 12-24 hours.  Lastly, once the wound is healed, apply sunblock over the area so that the skin color over the wound and surrounding skin look similar.

Alan L. Nager, M.D., M.H.A., has been Director of Emergency and Transport Medicine at Children’s Hospital Los Angeles for the past 18 years, and is a professor of Pediatrics at the Keck School of Medicine of the University of Southern California.

 

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