Treatment of and Response to Cuts and Bruises
The skin is the largest organ of the human body, about 2m square in surface area and has several functions. It is also a barrier which provides protection from infection and heat loss.
We need to remember that most cuts are minor and require little attention. The size of cuts, the number of cuts (also considering there may be other injuries) and the location of the cut increase the danger to the patient.
First aid and addressing small wounds, bruises, blisters and finger injuries.
Wounds comprise of injuries that break or remove the skin (such as cuts and abrasions). Most small wounds can be treated successfully at home. The aim of first aid is to promote healing and to minimise the risk of infection.
Large wounds or severe bleeding need immediate medical attention as blood loss can lead to falling blood pressure and shock.
Get help immediately if:
- The wound is large or deep and bleeding cannot be controlled after 10 minutes of applying pressure
- The person has lost of lot blood, is drowsy or pale
- There is numbness or weakness in the limb beyond the wound
- There is something stuck in the wound
- The person cannot move his fingers or toes
- Stitches are required
- The wound is on the face or neck
- Most minor wounds stop bleeding on their own. If bleeding continues, apply pressure to the wound with a clean bandage.
- Wash the skin around the wound with soap and water. Hold the wound under running water to remove dirt. Pat the wound dry with sterile gauze and apply an antiseptic ointment.
- In the case of cuts, close the wound with sterile adhesive wound closure strips. If strips are not available, cover the wound with clean gauze and adhesive tape or a bandage. Don’t use cotton wool. Adhesive non-adherent bandages can be used for abrasions that continue to ooze blood.
- Change the dressings at least once a day and watch for infection – remember that an infection will only be obvious after a day or two.
- For deeper cuts or severe bleeding, apply direct pressure onto the wound with a clean towel or gauze and follow first aid for severe bleeding.
- If there is a foreign object in the wound, don’t attempt to remove it. Apply pressure around the wound. Build padding around the object to the same height as the object and secure it with a bandage.
See a doctor if:
- There are signs of infection (such as extensive redness and swelling, a general sick feeling, pus from the wound or a temperature above 37.7°C).
- The wound has been contaminated with dirt or gravel and the injured person hasn't had a recent tetanus injection.
- The wound hasn't healed after two weeks. (Minor facial wounds usually take three to five days to heal, wounds on the chest and arms should take between five and nine days, and on the leg wounds, seven to twelve days)
- When stitches are required.
- If a wound doesn't close easily, the wound is deep (more than 0.6cm), gaping or jagged-edged, you may need stitches to promote healing, prevent infection and minimise scarring. Stitches are often necessary for small children as they tend to remove dressings, or if the cut is on the face or hands or joints. Stitching should be done within eight hours.
A bruise is dark discolouration of the skin caused by blood seeping under the skin after small blood vessels near the surface of the skin have been broken. As the bruise heals, the body breaks this blood down and reabsorbs it, turning the area a typical greenish-blue. Bruises are more common in people who are on treatment to prevent blood clots (warfarin, coumarin, heparin or aspirin).
- Change in colour of the skin (red, purple or black)
Get help immediately if:
- There is a bruise as a result of an injury to the loin or flank, and blood is present in the urine. This could indicate injury to the kidneys or other organs.
- The bruise is the result of a serious fall from a tricycle, bicycle or any other traumatic accident (a jungle gym tumble, for example). Your doctor may want to check for less obvious injuries.
- Head injury is followed by a bruise. You banged your head and have a bruise behind the ear; it may be a sign of a skull fracture.
- Most bruises are relatively minor and will get better on their own over a period of about ten days.
- If the bruise is quite large and swollen, then you can apply ice packs to reduce the swelling. This will also relieve the pain. Make an ice-pack by wrapping ice or frozen peas in a damp cloth. Don’t put it directly on the skin as this could cause damage. Put the ice-pack on for 10-20 minutes every two hours for the first 24 hours and every four hours for a further 24 hours.
- Elevate the area if the bruise is on a leg or an arm to reduce swelling.
- A pain killer such as paracetamol can be used if needed.
Call your doctor if:
- A bruise that doesn't fade in 14 days.
- The person is in pain for more than 24 hours or if pain on the site of the bruise gets worse; this may be caused by a broken bone.
Apart from the excellent First Aid Tips provided above we also decided to approach some of our experts in Emergency Medical Services with a Q&A.
What are the distinguishing factors between a Cut and a Bruise?
These wounds go through the skin to the fat tissue and are caused by a sharp object. The integrity of the skin is broken and there is external blood loss.
A laceration is a tear or cuts in the skin. A cut that does not penetrate entirely through the fibre layer (dermis) of the skin is called a "partial thickness" laceration. One that extends down into the fatty layer is called "full thickness."
These are internal bleeding into the skin from damaged blood vessels. Caused by a blunt object. They can occur without a cut or scrape.
When you receive a bump that makes small blood vessels under your skin bleed you will notice discolouration, and this is called a bruise. Your skin isn’t broken, so the blood doesn’t have anywhere to go. It pools and forms clots and changes the colour of the skin above the injury. The harder the blow, the bigger the bruise and this is also called contusions. They may be very tender to touch.
Management of bruises:
Cold can help with swelling as it stops the bleeding and may shrink the size of your black-and-blue mark. It also slows blood flow to the area, so less of it ends up leaking into your tissues. When you first get a bruise, take a bag of frozen veggies or fill a plastic bag with ice, wrap it in a towel, and gently put it on the injured area. Leave it there 15 to 20 minutes, take it off for 30 minutes or so, then put it back on.
What are the most important Characteristics of a Cut that would determine the first aid or medical steps to be taken?
Any cut that is gaping or wide open at rest needs sutures or what people generally refer to as stitches.
Cuts longer than 12 mm generally will need stitches, this; needs to be performed by a medical professional as soon as possible to prevent infection.
On the face, cuts longer than 6 mm should be seen by a GP and if needed can be closed with stitches or skin glue.
For minor cuts:
- Clean with warm water and gentle soap.
- Apply an antibiotic ointment to reduce the chance of infection.
- Put sterile gauze and bandage on the area.
Seek medical attention if:
- The cut is deep or over a joint.
- Blood Loss - Bleeding persists despite treatment. The bleeding needs to be controlled, depending on the size, depth and local of the wound. There are different methods and techniques to control blood loss. This can range from a small nic that stops bleeding spontaneously to large wounds which many require wound packing and the use of tourniquets.
- In line with controlling blood loss, especially with large wounds, the body tries to stop the bleeding by the formation of a blood clot, which forms in the wound. If this is dislodged bleeding could continue, we need to be aware of this and not aggravate the clot formation by excessive/ unnecessary washing of the wound (just after injury while still actively bleeding), removing and reapplying bandages unnecessary.
- To prevent infection. Cover the wound (from using plaster to a large bandage, depending on the size of the wound), this helps prevent contamination of the wound and assists in bleeding control.
- You cannot get the cut or laceration clean.
- 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.
- The cut is from a human or animal bite.
What are the most important Steps to take if a person has suffered a Cut?
- Apply direct pressure for 10 minutes to stop any bleeding.
- Wash the wound with soap and water.
- Cover the wound with a sterile gauze or a clean cloth until seen by a medical doctor.
What would be the factors indicating the need for professional medical treatment/ trauma care at a professional facility?
- Major bleeding that you are unable to stop using basic first aid techniques.
- A deep cut to the chest, stomach, head or neck (such as with a knife or glass bottle).
- If the skin is split open or gaping with dark red muscle or yellowish fat, this will need stitches.
- If the patient is in severe pain.
- A medical doctor must see a child with any type of burn aged less than a year old immediately.
- If the patient has dirt in the wound and does not wash out even after multiple rinses under water.
- If the person has sustained a very deep, scrape with skin loss and covers a large area.
- If the cut or scrape looks infected, (look for swelling, redness, pus or if the wound is warm to touch)
- If the person has never had a tetanus shot visit your nearest emergency department immediately, tetanus shots are not always available at all general practitioners consulting rooms.
- If it is, a child rather is safe than sorry, take them through to the nearest emergency department for a professional assessment.
- Wounds from rusted / old/ dirty objects.
- Wounds that are deep or long where bleeding control is difficult despite first aid treatment, especially if on the hands or face.
- Wounds that are rugged (don’t have a nearly straight edge).
- Stitches close the wound, which assists in stopping the bleeding and preventing pathogens from entering the wound to cause infection.
What are the most common mistakes in DIY treatment and steps to avoid in the treatment and response to a Cut?
- People underestimating the seriousness of the wound, a small wound left untreated may become serious later.
- Applying a tourniquet on a leg or arm for minor cuts, this is extremely risky and may result in the person losing a limb.
- Failing to clean the wound prior to applying dressings, which could delay the healing process.
- Removing scabs from a wound as it is believed to contain “dirty” blood.
- Do not insert any home-made remedies into a wound except ointment that is indicated and tested to promote healing. If stitches are required it must be inserted preferably within 6 hours.
- Not having first aid equipment available.
- Being scared to use first aid equipment.
- Waiting too long before seeking assistance with a wound.
What are the most important post-treatment signs that further medical treatment may be required?
If the wound is warm to touch, itchy, oozing pus, or has a foul smell or continues to bleed then you need to seek medical advice from a doctor.
Swelling, redness and if the area becomes warm and inflamed it is a sign to seek immediate medical attention.
Can’t control the bleeding despite first aid measures
Blood loss symptoms include
- Patient looks pale
- Clammy skin
- Dry mouth
- Anxiety/ confusion
What are the most important goodies to have in your Emergency Medical Kit to attend to Cuts and Bruises?
What type of cuts you expect to deal with will determine what is kept in your medical kit! In general, a variety of bandages, gauze dressings and an antiseptic ointment is generally used to treat minor cuts. There are various ways to treat bruises, ice therapy being the most popular, arnica oil has also proven to be very effective.
Depending on the size of the bag:
- Gloves (different sizes)
- Sterile water and cleaning agent/ disinfectant solution like Detol
- Sterile gauze and bandages of different sizes.
Use any means to a cool area (ice, frozen veggies even a “cold” cold drink can help to reduce swelling and bleeding under the skin.
The equipment must be available, with quick access to it.
The smaller the bag the greater the chance of it being carried around and being available in the time of need. There are several small bags that can fit on your belt, while there is limited equipment, its immediately available to start treatment while another bag is located and brought to the patient, which will take time.
A word of Appreciation to the Following for the Assistance Received:
Robert Mckenzie KZN EMS
Werner Vermaak, ER24
Shawn Herbst, Netcare 911
Pieter Oosthuizen, Life Healthcare
Mark Basson, Immediate Action Medical