You'll Need More than a Band-Aid
for Serious Wounds
by Obie Cuento, M.D.

Whether you're at the workplace operating machinery or at home doing yard work, accidents sometimes happen.

Puncture wounds and lacerations (open wounds) require immediate first aid and, often, professional medical assistance.

Puncture wounds commonly occur when someone steps on a nail, but they can also be caused by other sharp objects such as ice picks, knives, teeth, needles and construction tools such as nail and screw guns.

In most cases puncture wounds are minor and basic first aid treatment is all that's needed. However some puncture wounds call for professional medical treatment since there are infection risks associated with puncture wounds.

First, if dirt is pushed deeply into a puncture wound, an infection can result. Since these wounds have a small incision, it's not always possible to clean them sufficiently.

The second risk is that if a nail penetrates the skin and hits a bone, bacteria can be introduced into the bone. This risk is especially great if the nail has gone through a pair of tennis shoes, since the foam lining in tennis shoes can harbor bacteria (Pseudomonas) that can lead to serious infection.

Quick Care for Puncture Wounds

First aid for puncture wounds includes cleaning the area well and keeping the foot elevated for several days (depending on the severity of the puncture wound).

In addition, diabetics, the elderly, those persons taking drugs that can suppress the immune system (such as cortisone-related medications), or anyone who has suffered a particularly deep puncture wound should be seen by a healthcare professional.

This is particularly true if it was difficult to remove the nail, indicating that it may have penetrated the bone.

Seek professional care for a puncture wound if:
the bleeding cannot be controlled;
there is loss of feeling or movement in the area of the wound or below the wound;
the wound pierces the abdominal wall or chest area;
the wound appears to puncture a joint (such as a knee or a knuckle) and keeps pulling open when the joint is moved; or
the wound needs stitches.

Treating Open Wounds

For a simple scratch, careful washing with soap and water and covering it with a Band-Aid are probably adequate treatment.

However any laceration or cut that goes beyond the top layer of skin should be seen by a health care professional especially if it might need stitches (sutures). Generally, the sooner sutures are put in, the lower the risk of infection. Therefore, any cut that might need suturing should be seen as soon as possible.

If you have a serious, deeper wound that's bleeding heavily, follow these steps:

Apply firm, direct pressure to the cut with a sterile bandage or clean cloth. (Exception: If an object such as glass or metal is embedded in the laceration, applying pressure could drive it further into the wound. In this case, call 911 or take the person to a hospital emergency department immediately.)

Elevate the wound above the heart if the cut is on an arm or leg. Maintain pressure on the laceration. (Do not lift the area if you suspect a broken bone.)

Check whether bleeding has stopped after three or four minutes of direct pressure. If it hasn't, continue to press on the cut. (If blood soaks through the bandage or cloth, do not remove it; just add another dressing on top of the soaked one.)

If the bleeding doesn't stop after five minutes of direct pressure, seek medical attention immediately while you continue pressing on the wound. A long or deep cut may require stitches. Stitches typically stay in for a week or two before a doctor removes them.

Gently clean the wound with soap and water or antiseptic wipes once the bleeding stops. Apply an antibiotic ointment to prevent infection and reduce the risk of scarring, then bandage the cut with a sterile dressing. Change the dressing every day, and call the doctor if you notice any signs of infection, such as pus, oozing, swelling, redness, or fever.

When to Seek Medical Help for an Open Wound

Deep or jagged wounds often need to be closed by a physician, so go to a Sisters of Mercy Urgent Care Center or call your doctor if this appears to be the case. A delay in treatment could pose an increased risk for infection and scarring.

Call 911 or seek medical assistance right away if:

bleeding doesn't stop after approximately five minutes of direct pressure;
the wound was caused by a bite;
the cut is deep or is gaping open;
the wound has debris or dirt embedded in it that you can't clean out;
the injury was caused by a dirty object, such as broken glass on the ground;
there is no our sensation in the wounded area;
the wound is on the face, neck, head, or the palm side of the hands; or
the area appears infected.

Related Resources:

American Academy of Family Physicians -- Cuts, Scrapes, and Wounds

U.S. Department of Homeland Security. -- Make a First Aid Kit

Fall Physicals for School and Sports

School sports programs frequently also require a physical exam before suiting up. These exams ensure that students can safely participate in the sport they want to play, or it directs them to another type of activity that's more appropriate for them.

If your children still need a physical for school or sports, call your nearest Sister's of Mercy Urgent Care Center for an appointment-or just stop by at your convenience.

SEPTEMBER 2003

No appointment necessary
Open 7 days a week
Short waiting times
Convenient locations
Reasonable fees
Compassionate staff

Remember, you don't need an appointment, and visit times average less than 60 minutes.

Convenient locations near you

Urgent Care East
2313 U.S. Highway 70
Swannanoa, NC
828-686-4988
Weekdays:
– 9 a.m. to 5 p.m.
Saturday and Sunday:
– 11 a.m. to 5 p.m.

Urgent Care North
155 Weaver Boulevard
Weaverville, NC
828-645-5088
Weekdays:
– 9 a.m. to 5 p.m.
Saturday and Sunday:
– 11 a.m. to 5 p.m.

Urgent Care South
1812 Hendersonville Road
Asheville, NC
828-274-1462
Weekdays:
– 8 a.m. to 6 p.m.
Saturday and Sunday:
– 11 a.m. to 5 p.m.

Urgent Care West
8 New Leicester Highway
Asheville, NC
828-252-4878
Weekdays:
– 8 a.m. to 7 p.m.
Saturday and Sunday:
– 11 a.m. to 5 p.m.

Sisters of Mercy Urgent Care
445 Biltmore Avenue, Asheville, NC 28801  828-281-3498

Information in this newsletter should not be considered medical advice, which can only be given to you by your personal health care professional.