Should I Go to the ER or Not? A Look at Wound Care

Wounds – cuts, scrapes, injuries — happen. It’s a fact of life! Wounds will come in all shapes and sizes, under both mundane and bizarre circumstances. From the classic under-the-chin scrape to over-the-eyebrow lacerations, from the accidental kitchen knife injury to bicycle accident road rash, at some point in our lives, we will all encounter a variety of wounds.

The Importance of Keeping Calm

Although many approach wound care differently, certain truths apply in all circumstances. First, DO NOT PANIC, especially when kids are involved. Children are highly attuned to the emotional state of their parents. If mom and dad express anything other than reassuring calm to their little one, the wound care experience can become much more unpleasant. But this unpleasantness doesn’t need to happen, which brings me to my second point. Wounds all hurt to some degree. Expressing to the hurt child the importance of remaining calm is an important element of wound care.

The general approach to all wound care should be to minimize the risk of infection and to optimize healing in the most cosmetically acceptable way possible. All lacerations (cuts) leave scars, but not all scars will be noticeable if the healing process is managed correctly. Most wounds bleed; some even bleed quite a bit. However, unless a large vessel is damaged, all bleeding can be easily controlled with direct and firm, yet gentle, pressure. Apart from major scalp wounds, the loss of blood is usually negligible and not a concern.

Should I go to the Emergency Room?

Determining when a wound should be evaluated by a healthcare professional can be difficult sometimes. When in doubt, visit your primary care physician or the Emergency Room (ER), even if it’s only for a professional opinion and proper wound cleansing. Regardless whether you need to see a healthcare professional, there are certain actions you should take prior to evaluation.

The most important infection prevention measure? Cleaning the wound. Shortening the time between receiving the wound and cleaning it can help minimize infection and maximize healing. Does it matter what you use to clean the wound? Studies have shown that there is little difference between the effectiveness of clean tap water and expensive sterile saline solutions. Rinsing a wound with tap water at home (even in most major cities in China) does not increase the risk of infection. The use of antiseptics – such as iodine, beta-dine, alcohol or hydrogen peroxide – on a wound has minimal benefits, but using pressurized water does. Flowing water is more effective for clearing away bacteria from a wound. It is better to clean wounds with running water from a sink or shower nozzle than by scrubbing or dabbing with moistened gauze or towels.

Professional evaluation is recommended if a wound:

• Exposes underlying tissue
• Is contaminated with dirt or is difficult to clean due to pain
• Is related to an animal bite
• Is a deep puncture wound (especially if through a shoe)
• May have a retained a foreign body such as glass or vegetation
• Affects the function of a joint
• Involves the face
• May be over a fractured bone

Not all wounds require stitches; some should be left open. For example, animal bites are generally left open if they are not disfiguring. Some lacerations are too small to close or can be managed with medical adhesives. Surgical staples can be a good option for scalp wounds. The general rule of thumb is that facial wounds should be closed within 24 hours and other wounds within 18 hours. Cuts that are at high risk for infection can be left open for several days, and a healthcare professional can perform a delayed closure later.

After initial wound care, antibiotic ointment should be applied to the wound. Then cover it with a non-adhesive dressing. Most wounds (with or without stitches) can be gently washed with soap and water after 24 hours. Many wounds can be left open to the air after that, but I recommend applying antibiotic ointment twice a day. Avoid swimming with stitches or soaking a stitched wound. How long should stitches stay in? The time varies with the wound’s location, and your physician should be able to provide you a time range when you receive your stitches.

The use of oral/intravenous antibiotics to prevent wound infection is also somewhat controversial. The routine use of antibiotics is not beneficial for healthy individuals. Only high-risk wounds – such as some animal bites or punctures/lacerations that extend into joints, cartilage or tendons – are routinely treated with antibiotics. For recommendations about tetanus immunizations or booster shots, refer to guidelines published by the Centers for Disease Control (CDC) in the United States.

In summary, when you or your child get a wound:

• 1) Stay calm.
• 2) Clean wounds at home or as soon as possible with clean running water.
• 3) Apply firm-but-gentle compression to stop all bleeding (resist the temptation to check every five minutes).
• 4) Apply antibiotic ointment to a cleansed wound, and cover it with a dressing.
• 5) Consider prompt evaluation by a healthcare professional, based on the information above or if you have any other concerns.