Skin Injury - Cuts, Scrapes or Bruises

Symptoms

DEFINITION

• Cuts and Scratches: Superficial cuts (scratches) only extend partially through the skin and rarely become infected. Deep cuts (lacerations) go through the skin (dermis).
• Abrasions or Scrapes: An area of superficial skin that has been scraped off. Commonly occurs on the knees, elbows and palms.
• Bruises: Bruises (contusions) result from a direct blow or a crushing injury; there is bleeding into the skin from damaged blood vessels without an overlying cut or abrasion.

When are Stitches Needed?

• Any cut that is split open or gaping probably needs sutures (stitches). Cuts longer than 1/2 inch (12 mm) usually need sutures. On the face, cuts longer than ¼ inch (6 mm) usually need sutures.
• A physician should evaluate any open wound that may need sutures regardless of the time that has passed since the initial injury.

Liquid Skin Bandage for Minor Cuts and Scrapes:

• Liquid skin bandage has several benefits when compared to a regular bandage (e.g., a dressing or a Band-Aid). Liquid Bandage only needs to be applied once to minor cuts and scrapes. It helps stop minor bleeding. It seals the wound and may promote faster healing and lower infection rates. However, it is also more expensive. 
• After the wound is washed and dried, the liquid is applied by spray or with a swab. It dries in less than a minute and usually lasts a week. It is resistant to bathing. 
• Examples include: Band-Aid Liquid Bandage, New Skin, Curad Spray Bandage, and 3M No Sting Liquid Bandage Spray.

What is Tetanus?

• Tetanus is a rare infection caused by bacteria that are found in many places, especially in dirt and soil. The tetanus bacteria enter through a break in the skin and then spread through the body.
• Tetanus is commonly called "lock jaw" because the first symptom is a tightening of the muscles of the face.  However, the final stage of the infection is much more serious. All of the muscles of the body go into severe spasm, including the muscles that control breathing.  Eventually a person with a tetanus infection loses the ability to breath, and may die in spite of intensive treatment in the hospital.
• A tetanus booster protects you from getting a tetanus infection.  It does not prevent other kinds of wound infection.

When does an Adult need a Tetanus Booster Shot?

• Clean Cuts and Scrapes - Booster Needed Every 10 Years: Patients with clean MINOR wounds AND who have previously had 3 or more tetanus shots (full series), need a booster every 10 years. Examples of minor wounds include a superficial abrasion or a cut sustained while washing dishes. Obtain booster within 72 hours.
• Dirty Cuts and Scrapes - Booster Needed Every 5 Years: Patients with dirty wounds need a booster every 5 years. Examples of dirty wounds include those contaminated with soil, feces, saliva and more serious wounds from deep punctures, crushing, and burns. Obtain booster within 72 hours. When in doubt, assume that it is a dirty wound.

See More Appropriate Topic (instead of this one) If

• Animal caused it, see ANIMAL BITE
• It looks infected, see WOUND INFECTION
• Skin is punctured (not cut or scraped), see PUNCTURE WOUND
• BURNS
• SPLINTER OR SLIVER is present in the skin

FIRST AID Advice for Bleeding: Apply direct pressure to the entire wound with a clean cloth.

FIRST AID Advice for Severe Bleeding:

• Place 2 or 3 sterile dressings (or a clean towel or washcloth) over the wound immediately.
• Apply direct pressure to the wound, using your entire hand.
• If bleeding continues, apply pressure more forcefully or move the pressure to a slightly different spot.
• Act quickly because ongoing blood loss can cause shock.
• Do not use a tourniquet.

FIRST AID Advice for Penetrating Object: If penetrating object still in place, don't remove it (Reason: removal could increase bleeding).

FIRST AID Advice for Shock: Lie down with feet elevated.

FIRST AID Advice for Transport of an Amputated Finger or Toe:

• Briefly rinse amputated part with water (to remove any dirt).
• Place amputated part in plastic bag (to protect and keep clean).
• Place plastic bag containing part in a cup of ice water (to keep cool and preserve tissue).

Should I Call?

WHEN TO CALL YOUR DOCTOR

Care at Home

HOME CARE ADVICE FOR MINOR CUT, SCRAPE, OR BRUISE

1. Treatment of Minor Cuts, Scratches and Scrapes (abrasions):
   • Apply direct pressure for 10 minutes to stop any bleeding.
   • Wash the wound with soap and water for 5 minutes.
   • Gently scrub out any dirt with a washcloth.
   • Cut off any pieces of dead loose skin using a fine scissors (cleaned with rubbing alcohol before and after use).
   • Apply an antibiotic ointment, covered by a Band-Aid or dressing.  Change daily.
   • Another option is to use a Liquid Skin Bandage that only needs to be applied once. Avoid ointments with this.
2. Treatment of Minor Bruise:
   • Apply a cold pack or an ice bag wrapped in a towel for 20 minutes each hour for 4 consecutive hours (20 minutes of cold followed by 40 minutes of rest for 4 hours in a row).
   • 48 hours after the injury, use local heat for 10 minutes 3 times each day to help reabsorb the blood.
   • Rest the injured part as much as possible for 48 hours.
3. Pain Medicines:
   • For pain relief, take acetaminophen, ibuprofen or naproxen.
   • Acetaminophen (e.g., Tylenol):
     • Take 650 mg by mouth every 4-6 hours. Each Regular Strength Tylenol pill has 325 mg of acetaminophen.
     • Another choice is to take 1,000 mg every 8 hours. Each Extra Strength Tylenol pill has 500 mg of acetaminophen.
     • The most you should take each day is 3,000 mg.

   • Ibuprofen (e.g., Motrin, Advil):

     • Take 400 mg by mouth every 6 hours

     • Another choice is to take or 600 mg by mouth every 8 hours.

     • Use the lowest amount that makes your pain feel better.

   • Naproxen (e.g., Aleve)

     • Take 250-500 mg by mouth every 12 hours.

     • Use the lowest amount that makes your pain feel better.

   • Extra Notes

     • Acetaminophen is thought to be safer than ibuprofen or naproxen in people over 65 years old. Acetaminophen is in many OTC and prescription medicines. It might be in more than one medicine that you are taking. You need to be careful and not take an overdose. An overdose can hurt the liver.

     • Before taking any medicine, read all the instructions on the package.

4. Expected Course: Pain and swelling usually begin to improve 2 or 3 days after an injury. Swelling is usually gone in 7 days. Pain may take 2 weeks to completely resolve.
5. Call Your Doctor If:
   • Looks infected (pus, redness, increasing tenderness)
   • Does not heal within 10 days
   • You become worse

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

Photo Example

Abrasion on Shoulder

This individual fell and scraped his shoulder on the sidewalk. The picture shows a shallow abrasion with minor bleeding.

First Aid Care Advice for Minor Abrasion:

• Apply direct pressure for 10 minutes to stop any bleeding.
• Wash the abrasion with soap and water.
• Gently scrub out any dirt with a washcloth.
• Apply an antibiotic ointment, covered by a gauze dressing. Change daily.
• Another option is to use a Liquid Skin Bandage that only needs to be applied once. Avoid ointments with this.

Scratches from a Cat

The photo shows 3-4 parallel scratches on the wrist caused by a cat.

First Aid Care Advice:

• Wash the scratches with soap and water.
• Apply an antibiotic ointment twice daily.
• Watch closely for signs of infection, especially the first 1-3 days.

Bruise on Thigh (1 Day Old)

This bruise is one day old.

Bruises (contusions) result from a direct blow or a crushing injury; there is bleeding into the skin from damaged blood vessels without an overlying cut or abrasion.

Bruise on Shoulder (4 Days Old)

This bruise is four days old.

Bruises (contusions) result from a direct blow or a crushing injury; there is bleeding into the skin from damaged blood vessels without an overlying cut or abrasion.

Source: LMS Inc.

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Source: Wikimedia Commons

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