Wounds

Bumps and Bruises

Bruises, everyone gets them. Those ugly discolored patches that appear after you do something like slamming your elbow into the wall behind you, or taking a trip over your feet and falling hard. A bruise is caused by the damaging or breaking of a blood vessel, because of a blow to the skin. Some people bruise more easily than others. Children, for example, bruise much less easily than an elderly person would. Medications that interfere with blood clotting also help people to bruise more easily. Warfarin, a drug often prescribed to prevent clotting in those who have had clots in the legs or heart, can cause people to bruise severely.

Why do bruises change color?

Bruises are fairly predictable, you can often tell how old they are just by looking at them. When they first appear they will be reddish, a reflection of the blood trapped in the skin. After 1-2 days the bruise will appear blue or purple. By day 6 or so the bruise will be green and around days 8-9 it will be a yellowish brown. Usually the bruised area will look normal within 2-3 weeks.

What if it doesn’t get better or it stays swollen?

Sometimes this happens. If the bruise becomes firm and actually seems to become larger two things may have led to this. First of all, when the blood vessel broke, if it was a large amount of blood the body might have decided just to wall it off, rather than clean it up. This bump is called a hematoma, and it may need to be drained by your doctor.

A second problem, which is much less common, is when the body deposits calcium in the area of the injury. This area then becomes tender and firm and requires x-rays and a trip to the doctor. This condition is called heterotopic ossification.

Other kinds of bruises:

Petechiae are little (3-3 millimeters) red dots that appear anywhere on the body, although the legs are most common. They are tiny little accumulations of blood. Often there are few of them and they usually indicate some sort of serious health problem.

Bruising around the belly button could be a result of bleeding in the abdomen.

Bruising behind the ear can indicate a skull fracture

And lastly bruises that are raised, firm, and occur without any injury may be signs of a “autoimmune” disease, in which the body attacks it’s own blood vessels. Your doctor should evaluate all of these sorts of bruises.

How to treat bruises:

When bruising first occurs you can minimize the effects by using a cold compress. Place the ice in a bag or towel, as placing ice directly to the skin can cause frostbite. The cold reduces the flow of blood to the area and therefore reduces the size of the bruise. It also decreases the inflammation in the area and decreases swelling. If possible elevate the area to slow the blood flow. The lower the area is in relation to the heart the larger the bruise can be. Applying pressure also helps reduce blood flow and swelling. Another thing is to avoid medications that make it easier to bruise, however it is vital that you consult your doctor before making any changes to the medications you’re on.

Cuts and Scrapes

How do I care for cuts and scrapes?

With all cuts and scrapes the most important thing to do first is to clean out the wound. Make sure you wash your hands before cleaning a wound to avoid transferring more dirt to the cut. Always wipe away from the wound when removing dirt and other particles that may be in the wound. When washing the wound use soap and water, but do not scrub because that may do more damage. Hydrogen peroxide may be used but it is no substitute for soap and water! Also in some cases iodine and hydrogen peroxide will delay healing. After the wound has been thoroughly washed look at it and determine how bad it is bleeding. Apply direct pressure with a clean dry cloth or sterile gauze bandage, while elevating limb (if possible) above the heart. This will slow bleeding and help a clot to form. If bleeding is spurting out of wound or bleeding continues heavily after pressure has been applied for 5-10 minutes stitches may be needed, so go to the hospital and have the wound checked out by your doctor as soon as possible. If the bleeding slows however cover the wound with a clean bandage. You may wish to apply a thin layer of antibacterial ointment to the wound first, to protect against infection. If the wounds are on the hands or feet avoid using these ointments after the first day. Make sure the wound is kept clean and dry while it heals. It is good to clean the wound and apply fresh bandages daily. To keep smiles on faces of those young and old try some of Crackles’ funky bandages in zebra, rainbow, smiley faces, dinosaur and more!

Ointments:

chose your ointment carefully. Some ointments like Bacitracin and Neo-mycin are common and best suited for small or minor cuts. If a large area is affected or if it is a more sever cut consult your doctor before using any ointments. It is advised to call your doctor if you have any ointment questions.

If wound has not been properly cleaned the ointment may seal in bacteria. Another thing to be wary of is using too much ointment. If to much is applied it can increase the chance of infection, as bacteria is attracted to moisture. Apply only a thin layer to ensure the best protection.

Always apply the ointment with a clean swab or gauze. Applying ointment from the tube may contaminate the tube and put future wounds at risk.

Ointments may be used up to three times daily, but it is not very commonly recommended. Overuse of ointments may cause allergic reactions and will delay healing. Make sure to wash the wound before applying fresh ointment.

Who should always go to the doctor for minor wounds?

Diabetics and people who either have a long-term illness or are taking drugs that suppress the immune system should always go to the doctor, as they are in a more fragile state and are at greater risk of getting an infection.

What are signs of infection?

If the wound begins to drain greenish fluid, or is the skin around the wound is red, swollen and increasingly painful. Signs of an infection, known as Lymphangitis, is any red streaking on the skin around the wound may indicate an infection where fluid is draining from the tissues in the lymph system. This can be serious especially is accompanied by a fever. If signs of this infection are seen, get to the doctors as soon as possible.

Taking proper care of a wound by keeping it clean and covered can often prevent infection. Airtight bandages are recommended over “breathable” bandages. When applying fresh bandages make sure your hands are clean and the bandage remains sterile. It is advised that the bandage is opened over the wound and that the pad remains untouched except by the wound.

If wounds are neglected the following signs mean trouble.

Redness, swelling, increased warmth and tenderness around the wound

A strong or displeasing odor

Chills and or fever

The red streaking of Lymphangitis

Pus or watery discharge coming from the wound or collected beneath the skin around the wound.

Classification of wounds

Incision: These cuts are often the result of some sharp object such as broken glass, knives and sharp edges. The amount of bleeding varies on the depth and extension of the cut. Some of these wounds require stitches.

Laceration: These are jagged irregularly shaped cuts or tears in the skin. Most lacerations are serous and require stitches, because of heavy bleeding. Chances of infection depend on the size, cause, and depth of the laceration. If the laceration seems severe, it should be seen and treated by a doctor. In these cases cover the wound with a clean cloth or sterile covering and seek medical treatment as soon as possible.

Punctures: Puncture wounds are caused by an object piercing the skin. These wounds range from minor to severe and should often be looked at by a doctor. The cause of a puncture wound is important, for example, if a rusted nail causes the wound the risk of infection is high and a tetanus shot may be needed. Splinters, glass, nails, pins, and other objects can also cause these wounds. Because the wound penetrates the skin (and in some cases, several layers of skin) they are often difficult to clean and infections are common.

In some cases, the puncture wound is very deep, such as a nail puncturing the foot. At times, the nail or other object may puncture the bone and introduce bacteria. These wounds are often marked by having difficulty removing the object from the affected area. If bone puncture is suspected, visit your doctor as soon as possible.

In more minor puncture wounds infection is not as common, but if redness and swelling persist, contact your doctor.

What about those tetanus shots?

Most people (in the U.S) have been immunized against this bacteria. If it has been five years since you received your last booster shot, and you get a puncture wound, you should get another to protect against tetanus infection. If you’ve never had a tetanus shot, or you have had fewer than three shots you may need to take a medication known as Tetanus Immunoglobulin to prevent the infection of this bacteria.

*Severe bleeding injuries

Lay the person down. If possible, position the person’s head slightly lower than the trunk, or elevate the legs. This position reduces the chances of fainting by increasing blood flow to the brain. If possible, elevate the site of bleeding.

Remove any obvious debris or dirt from the wound. Do not remove any objects pierced into the victim. Do not probe the wound or attempt to clean it at this point. Your principal concern is to stop the loss of blood.

Apply pressure directly on the wound with a sterile bandage, clean cloth or even a piece of clothing. If nothing else is available, use your hand.

Maintain pressure until the bleeding stops. When it does, bind the wound tightly with adhesive tape or a bandage. If none is available, use a piece of clean clothing.

If the bleeding continues and seeps through the gauze or other material you are holding on the wound, do not remove it. Instead, add more absorbent material on top of it.

If the bleeding does not stop with direct pressure, you may need to apply pressure to the major artery that delivers blood to the area of the wound. In the case of a wound on the hand or lower arm, for example, squeeze the main artery in the upper arm against the bone. Keep your fingers flat; with the other hand, continue to exert pressure on the wound itself.

Immobilize the injured body part once the bleeding has been stopped. Leave the bandages in place and get the injured person to the emergency room as soon as possible or, if they cannot be moved, call 911 in the U.S. & Canada

*Information on severe bleeding from: www.coolnurse.com

*** Before administering any first aid to anyone outside your family, be aware of your rights and responsibilities: The Good Samaritan Law. ***