Puncture Wound

Symptoms

DEFINITION

  • Skin is punctured by a narrow sharp object (e.g., a nail, pencil, toothpick)

General Information

  • Needlesticks: Any needlestick from a used or discarded needle should be reported immediately to the doctor. In some cases, medicines should be started to prevent transmission of the HIV (AIDS) virus.
  • Foot Punctures through Athletic Shoes: Puncture wounds into the bottom of the foot have a risk of infection of approximately 4%. This increases to 25% in patients with puncture wounds through athletic (tennis) shoes into the bottom of the foot near the toes. Pain persisting greater than 4-5 days after the injury is suggestive of infection.
  • Pencil Lead Punctures: Pencil lead is actually graphite (harmless), not poisonous lead. Even colored leads are nontoxic. However, they will cause a tattoo and should be scrubbed out.

See More Appropriate Topic (instead of this one) If

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

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

Should I Call?

WHEN TO CALL YOUR DOCTOR

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

Call Your Doctor Now (night or day) If
  • You think you have a serious injury
  • Severe pain
  • 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 is still in the wound
  • Can't stand (bear weight or walk) on punctured foot
  • Needle stick from used injection needle, and you were possibly exposed to another person's blood
  • Sharp object was very dirty (e.g., a barnyard)
  • Setting was dirty and puncture occurred on bare foot
  • Dirt (debris) that can be seen in the wound is not gone after 15 minutes of scrubbing
  • Wound looks infected (redness, red streaks, swollen, tenderness)
  • Fever
  • No previous tetanus shots 

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think you need to be seen
  • Diabetic and puncture wound of foot
  • Last tetanus booster was over 5 years ago

Call Your Doctor During Weekday Office Hours If
  • You have other questions or concerns
  • Puncture through shoe (e.g., tennis shoe) and into bottom of foot
  • Pain has not improved after 3 days

Self Care at Home If
  • Minor puncture wound and you don't think you need to be seen

Care at Home

HOME CARE ADVICE FOR MINOR PUNCTURE WOUND

  1. Cleansing: Wash the wound with soap and warm water for 15 minutes. For any dirt or debris, scrub the wound back and forth with a washcloth to remove it.
  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 and a Band-Aid to reduce the risk of infection. Re-soak the area and re-apply an antibiotic ointment every 12 hours for 2 days.
  4. 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):

    • Naproxen (e.g., Aleve)

    • 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.

  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
    • It begins to look infected (redness, red streaks, tenderness, pus, fever)
    • Pain becomes severe
    • You become worse

And remember, contact your doctor if you develop 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.

 

Author and Senior Reviewer: David A. Thompson, M.D. Clinical content review provided by Senior Reviewer and Healthpoint Medical Network.

Last Review Date: 11/18/2011

Last Revised: 11/18/2011

Content Set: Adult HouseCalls Symptom Checker

Version Year: 2012

Portions Copyright 2000-2012 Self Care Decisions LLC; Copyright LMS, Inc.

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.

Instructions: The first purpose of Adult HouseCalls Symptom Checker is to help you determine how sick you are and if you need to call your doctor. The second purpose is to help you treat yourself at home when it is safe to do so. Your doctor's advice and your good judgment should always take precedence over information in these topics.

When to Call Your Doctor

Copyright 

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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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