Injuries to the skin are one of the most common injuries an individual can sustain. These injuries can range in severity as well as well as complexity of treatment. Wounds may be superficial and linear (which are very painful) such as paper cuts, or deeper (as in lacerations), they can also be abrasions (scraping of the skin), punctures of the skin can be another common injury, and the last classification of traumatic wounds to the skin are avulsions (tearing of the skin). Injuries to the skin though are universally approached in a pretty straight manner. Compression is the standard first line of treatment, and this is usually an instinctual response. Inspecting the wound usually follows and this also is often instinctual.

When administering first aid to a bleeding individual (not yourself) ALWAYS wear medical grade protective gloves to prevent transmission of HIV / Hepatitis or any other blood borne pathogen. Everyone should have several pairs in their first aid kits. Another point to bear in mind is that if the injury is a deep puncture wound or the person has not had a recent (within the last 5 to 10 years) tetanus shot or booster or if the cut is from a human or animal bite – immediate medical attention should be sought.

Lacerations & Avulsions:

A laceration is a wound that penetrates all layers of the skin and may also continue into subcutaneous fat, muscle, blood vessels, and nerves. A laceration will display a gap in the skin that can be opened or closed when pressure is applied along the sides of the wound.

  • Stop the bleeding: application of pressure with a clean cloth, rag, or gauze for 1 – 3 minutes is usually enough for smaller wounds. If you still have “oozing” – you may need to apply continual pressure for 20-30 minutes. Don’t keep checking to see if the bleeding has stopped because this may damage or dislodge the clot that’s forming and cause bleeding to resume. If blood spurts or continues flowing after continuous pressure, this may indicate injury to an artery or a major vessel and can be a life threatening injury. If bleeding is severe, you can consider applying a tourniquet to the area proximal (nearer to the heart) to the injury. Tourniquets should always be attempted to be placed over a wide as possible area to prevent tissue damage from the pressures applied by the tourniquet.
  • There are several chemical coagulation products out there which are very effective. I personally do not use them since they are kind of expensive, have an expiration date and I have gotten by on several occasions without the need for such a product – even with real massive wounds I have treated. Just be aware that there are other products out there.
  • Once bleeding has minimized or even stopped, it can be carefully rinsed or flushed out with sterile saline solution, sterile water (boiled & filtered), or peroxide. I recommend NOT using peroxide more than after the initial injury since it can dislodge blood clots as well as be toxic to the local cells necessary for healing. I always perform a saline flush after using peroxide. The area surrounding the cut can be cleansed with commercially available antiseptic wipes or simple soap and water – with care taken to minimize the soap which gets into the wound.
  • Dry the wound well & it is usually a good idea to apply a thin film of antibiotic ointment and dress the wound with a bandage.
  • Sometimes lacerations need suturing (stitches). This promotes healing and reduces scarring. The length of time stitches stay in depends upon the location of the laceration, its length and/or depth, and associated tissue damage. If the laceration Is not very deep or long, adhesive strips (“Steri-strips”) can be used to bring a clean, uninfected cut together. I always carry them in my first aid kit. “Butterfly” bandages help serve this purpose also, as does superglue”

Abrasions:

  • An abrasion is the removal of the top layer or layers of skin by the friction of anything rubbing directly on the skin. Usually, an abrasion oozes blood or fluid from injured capillaries (small blood vessels). Because superficial nerve endings in the skin are exposed, abrasions tend to be very uncomfortable.
  • As soon as possible, clean the abrasion with clear water and soap (remember to wear gloves at all times if not treating yourself). A surgical soap, Chloraprep, Betadine, or Hibiclens, is preferable, but any mild soap without fragrance can be used. Try to remove all foreign material from the wound using a clean bandana, cloth or preferably sterile gauze pads. If you cannot remove all imbedded material, seek additional medical care. Remaining material may cause infection or tattooing of the skin.
  • Generally, abrasions should be covered and kept moist. Maintain a moist environment, though covering the wound with an anti-bacterial ointment, or applying a gauze pad moistened with sterile saline and then wrapping the area or covering the area with a dry bandage. Change this dressing once or twice a day until healing is complete. When an abrasion is over a joint or a moving body part, keep the abrasion moist until healed.
  • Puncture wounds:

    • Puncture wounds have a high association with infection. Once the bleeding has been controlled (as above), wash the area similar to how you’d wash an abrasion (see above) and monitor for signs if infection (pain redness / swelling / oozing / pus / odor). Seek professional medical attention as soon as possible if any of the signs of infection occur.
    • Puncture wounds to the chest can cause collapsed lungs – monitor for signs of painful or shallow breathing or breathing which is becoming shallower. If any of these signs occur -apply tape (duct tape is awesome for this type of application) or an impermeable bandage to “seal” the air leak which is causing the lung to collapse. Get the victim to a hospital ASAP.
    • Puncture wounds to the neck & back are especially dangerous for nerve or spinal cord damage & the severity of the injury / situation needs to be evaluated before any action is taken.
    • Puncture wounds to the abdomen can be concerning for injury to the intestines or other organs. Watch for signs of internal bleeding such as a distension (ballooning out) of the abdomen, abdominal pain, nausea or diahrrea. This is a medical emergency that needs to be taken to the hospital ASAP.

    Remember to have a high quality – well stocked first aid kit as well as medical grade gloves. Duct tape, some extra clean bandanas or rage and superglue are always in my bug out and hiking bags! The most important thing to remember in any medical emergency is to STAY CALM!!

    Until next time – stay healthy! Dr. E

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5 Responses

  1. Bryan

    good descriptions of the individual injuries. Was wondering your thoughts on using Krazy glue on minor cuts as I have been told by a nurse that is basically the same thing as surgical glue. I know that to use this method you have to press the wound closed and ONLY apply the glue to the top of the cut, NOT inside.

    Reply
    • c.caudill

      We highly recommend Krazy/super glue just as you have described here. We are not physicians so you might want to follow up with one if you know one. HOwever, we have used this glue on cuts, scrapes and virtually all small wounds that we want to keep debris and other unwanted items out of the wound itself. HOpefully the Doc will get on here and tell us his thoughts soon. Whatever he says I would go with rather than my recommendation, since I am not a medical professional.

      Reply

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