Puncture Wound

Symptoms

DEFINITION

  • The skin is punctured by a narrow, pointed object

Causes

  • Commonly caused by a nail, sewing needle, pencil, toothpick
  • Pencil lead is actually graphite (harmless), not poisonous lead. Even colored leads are not toxic.

See More Appropriate Topic (instead of this one) If

Should I Call?

WHEN TO CALL YOUR DOCTOR

Call 911 Now (your child may need an ambulance) If
  • Puncture on the head, neck, chest or abdomen that may go deep

Call Your Doctor Now (night or day) If
  • You think your child has a serious injury
  • Bleeding that won't stop after 10 minutes of direct pressure
  • Puncture on the head, neck, chest, abdomen that isn't deep
  • Puncture overlying a joint
  • Tip of the object is broken off and missing
  • Feels like something still in the wound
  • Won't stand (bear weight or walk) on punctured foot
  • Needle stick from used or discarded injection needle
  • Sharp object or setting was very dirty (e.g., a barnyard)
  • No previous tetanus shots
  • Dirt (debris) or pencil lead pigment is not gone after 15 minutes of scrubbing
  • Severe pain
  • Wound looks infected (redness, red streaks, swollen, tenderness)
  • Fever occurs
  • You think your child needs to be seen urgently

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think your child needs to be seen, but not urgently
  • Last tetanus shot over 5 years ago

Call Your Doctor During Weekday Office Hours If
  • You have other questions or concerns

Parent Care at Home If
  • Minor puncture wound and you don't think your child needs to be seen

Care at Home

HOME CARE ADVICE FOR PUNCTURE WOUND

  1. Cleansing:
    • Wash the wound with soap and warm water for 15 minutes.
    • For any dirt or debris, scrub the wound surface back and forth with a wash cloth to remove it.
    • If the wound re-bleeds a little, that may help remove germs.
  2. Trimming: Cut off any flaps of loose skin that seal the wound and interfere with drainage or removing debris. Use a fine scissors, after cleaning them with rubbing alcohol.
  3. Antibiotic Ointment: Apply an antibiotic ointment such as Polysporin (no prescription needed). Then, cover with a Band-Aid to reduce the risk of infection. Re-wash the area and re-apply an antibiotic ointment every 12 hours for 2 days.
  4. Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen for any pain.
  5. Expected Course: Puncture wounds seal over in 1 to 2 hours. Pain should resolve within 2 days.
  6. Call Your Doctor If:
    • Dirt in the wound persists after 15 minutes of scrubbing
    • Pain becomes severe
    • It begins to look infected (redness, red streaks, tenderness, pus, fever)
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

Photo Example

X-Ray - BB in Left Upper Arm

This X-Ray shows BB in the left upper arm.

Puncture Wound - BB Gun

This photo shows a puncture wound from a BB gun in left upper arm. Note the small hole in the arm where the BB struck and entered the skin.

First Aid - Removing a Fishhook

This is method of fishhook removal is sometimes referred to as the Advance and Cut Method.

There are four steps in removing a fishhook using this this method:

  1. Step 1. Using pliers (or needle drivers) firmly grasp the hook.
  2. Step 2. Push (advance) the hook until the tip of the hook pops out through the skin.
  3. Step 3. Cut off the tip of the hook (and the barb).
  4. Step 4. Pull (back out) the hook out.

Important Note:

  • These instructions assume that you can not get into see a doctor right away. In most circumstances it is best to have a physician (or other licensed health care provider) remove an embedded fishhook.
  • The hook in this drawing has only a single barb at the tip, and thus the tip of the hook (with the barb) can be cut off and the hook pulled backwards through the skin.
  • Some hooks can have more than one barb along the shaft of the hook. In such cases, it is better to cut off the ring at the bottom of the hook and push the hook all of the way through the skin.

Puncture Wound - With a Foreign Body

There is a small metal splinter (foreign body) embedded in the palm of the hand.

This patient went to the emergency department and had the splinter removed.

Source: LMS Inc.

Copyright 2000-2009. Self Care Decisions, LLC. Used by Permission.

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Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D. Clinical content review provided by Senior Reviewer and Healthpoint Medical Network.

Last Review Date: 6/1/2011

Last Revised: 8/1/2011

Content Set: Pediatric HouseCalls Symptom Checker

Version Year: 2012

Copyright 1994-2012 Barton D. Schmitt, M.D.

Is Your Child Sick?

Pediatric HouseCalls Symptom Checker is a parent guide for treating your child at home, calling your child's doctor or seeking immediate medical attention. Developed by Dr. Barton Schmitt, MD, FAAP, a board-certified pediatrician on staff at Children's Hospital Colorado. Dr. Schmitt has developed other health tools for parents, including the 3rd edition of Your Child’s Health (available in bookstores) and KidsDoc, a new iPhone and Android app for parents (available online).

Are You Sick?

David A Thompson, MD is the author of Adult HouseCalls Symptom Checker. He is a board-certified emergency medicine physician at Northwestern Memorial Hospital in Chicago. He has a national reputation in telephone triage, decision support tools, medical information technology and quality improvement. Adult HouseCalls Symptom Checker is a decision support tool for adults that has been reviewed and approved by adult physicians.

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