Wound Care



Wound Care

BRUISES AND HEMATOMAS
Bruises (also called contusions) usually form a bluish discoloration at the site of the injury and fade from blue to green to yellow over one to two weeks.
A hematoma (goose egg) is a collection of blood and swelling in the skin or just underneath it. Depending upon its size and location, this swelling will go down in one to ten days.
Apply ice intermittently to the injured area for a few days. The ice can be applied for 20 minutes every two to four hours and will help to limit bleeding into the tissues. If your child won’t allow you to put ice on the bruised area, it will still heal fairly quickly in most cases.
ABRASIONS
Abrasions (or scrapes) are broad areas of superficial skin damage; they seldom result in any deep underlying damage and rarely leave a significant scar. They heal quickly and usually do not become infected.
Treatment
Cleanse the wound gently with warm soapy water to remove any dirt and debris. A painless antiseptic such as hydrogen peroxide can help cleanse an abrasion.
Apply an antibiotic ointment such as a neomycin-polysporin mixture (Neosporin) or one prescribed by your child’s physician. Cover with a nonstick wound dressing to keep it clean.
Change the dressing once or twice daily until the wound is no longer moist and sensitive.
LACERATIONS
A laceration can range from a minimal break in the skin surface, requiring only a brief cleansing and a day or two of a simple dressing, to a long, gaping wound requiring extensive repair. A deep laceration may damage tendons, nerves, joints, or other underlying tissues. It may also contain dirt or other foreign material that can lead to infection. Because of these potential complications, most wounds deeper or wider than I or 2 mm should be examined by a physician to determine appropriate treatment.
Treatment First aid for lacerations that might require sutures (stitches) includes the following:
Apply steady pressure with clean gauze or washcloth to stop bleeding.Keep the area clean.
Rinse with clean water if available.
Keep covered with a sterile bandage, or at least a clean cloth, until the wound can be examined by a medical professional.
A laceration should be closed within 24 hours. The sooner the
wound is treated, the less likely it will become infected. If a laceration is not sutured, the consequences are usually not serious, but healing could take longer and the resulting scar is likely to be wider or more prominent.
Sometimes lacerations are deep enough to involve injury to a nerve or tendon. For this reason, any laceration that looks deep at all should be examined and cleaned by your child’s physician or another medical professional.
WHEN SUTURES ARE NOT USED
With some contaminated lacerations or certain types of animal or human bites, the physician may not use sutures because closing the wound could increase the risk of infection. In such cases the wound will be left open, but it will gradually heal as the body’s repair processes close the defect.
CONCERNS ABOUT TETANUS
Any laceration, puncture, bite, abrasion, or burn should prompt a review of a child’s tetanus
Immunization status. Tetanus is a potential threat following any wound, but it is a greater, tern following punctures or contaminated wounds. If a child is on schedule for Isis or hernunizations or is fully immunized, no tetanus update will be needed. Otherwise a tetanus booster should be given.
SIGNS OF INFECTION
Signs and symptoms of infection include local pain, swelling, and redness, which may cover a large area around the wound. There may also be fever. Inflammation of local lymph channels may form a red streak that extends away from the wound. Some bacteria can the production of discolored drainage (or pus). If a wound appears to be level wing an infection, show it to a physician. Mild heat on the affected area, rest, elevation of the affected area (if an arm or leg), and antibiotics will most likely be recommended.
THE IMPORTANCE OF FOLLOW-UP
Be sure to obtain specific wound-care instructions before leaving the office or emergency facility. In general, if sutures or sterile strips have been used, the wound should be kept dry for a few days. This will mean that the child should not go swimming or soak the wounds while bathing. In some cases, the physician may instruct you to clean the wound and apply fresh dressings. He or she should also tell you when the strips or bandages should be removed. A follow-up appointment is usually required when stitches need to be removed.