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  #1  
Old 02-26-2010, 09:51 AM
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Default First Aid for Cuts

I was reading the post about a members cut, and decided to start a thread about first aid for cuts.

I am a retired Physician Assistant, and worked in the surgical field for 25 years, so I have bit of knowledge about wounds (cuts are just a clean wound).

The information I will give is GENERAL IN NATURE, AND NOT SPECIFIC TO AN INDIVIDUALS INJURY:

Immediate care: It is best to wash thoroughly with soap and water, any kind is acceptable (hand soap, anti-bacterial, dish soap). The type of soap is not important, the main benefit of washing is the mechanical removal of foreign bodies, if no soap is available it is almost as effective to wash and scrub with plain running water. You should GENTLY scrub the wound (soft wash rag, cloth, soft brush) to remove foreign debris. It is of no to limited benefit to soak the wound in anything, be it soap, epsom salts, etc.

WHEN DO YOU NEED STITCHES:
The rule of thumb (no pun) is to sew it when the edges are more than a couple of millimeters apart in the resting position ( wrist flexed slightly and fingers curled into the shape of the letter C) or if the edges gape apart significantly when the area is stretched by movement. This means.."if the edges don't touch or come close, it will take a lot longer to heal and the scar will be much thicker" Depth of the wound is also important, as a deep wound may need stitches down in the wound to hold lower layers of tissue together as well as stitches on the surface. If the skin is closed over a significantly deep wound, the lower layers may still be seperated, and thus a "pocket" or cavity os formed under the closed skin. This pocket is an excellent place for blood or tissue fluid to accumulate and that is the perfect spot of an abscess to form. Rule of thumb : a cut that is deeper than it is long has the potential to need advanced care or closer observation than a shallower cut.

OINTMENT, CREAMS PEROXIDE,ETC:
Peroxide is OK for initial cleaning, but after the first wash, do not use again as it can potentially damage tissue with prolonged exposure. The fizzing isn't really anything to do with cleaning the wound, is just a chemical reaction that releases oxygen and causes the bubbles. Iodine is not reccomended as it is toxic to tissues. You may have Betadine (trade mark) which is the iodine based brown soap that OR's and Drs use to clean wounds. Betadine is more dilute than regular iodine in respect to the iodine concentration and is ok, but again just for the initial cleaning. The combination of betadine/iodine and peroxide is a serious no-no, combined this causes the iodine to percipitate as a solid and seriously damages tissue as it stays in the wound for a long time.

All creams (neosporin, polysporin, first aid creams, etc) are ok at first. The Dr./provider will often apply a thin film of a cream immediatly after sewing a wound, but the purpose is to make an impermiable barrier over the open wound for the first 24 hours to help prevent the entry of new bacteria. The type/brand of cream at this stage is of no real signifigance, it is the mechanical barrier that is of value. The creams are NOT usually reccomended for long term use, as they retain moisture and as mentioned in the post that prompted this one cause maceration of the skin. Maceration is a ten dollar word for wet and icky, like when your hands "prune" in the tub. Wet is a breeding ground for germs, and also delays healing on its own, dry and exposed to the air is a good thing once the initial "stick" has the wound edges together.

BANDAGES: they cover the wound and are of benefit to cut down on the entry of bacteria into the wound. They serve another purpose, which is to remind folks to keep the wound dry and protected, and they may help prevent excessive movement of the area which can in some cases slow healing if the edges are subjected to excessive strain, pulled apart repeatedly, or otherwise prevented from making contact with each other.

SUPERGLUE/ADHESIVES; definetly used by health providers and surgeons. They work well, easy to apply. The only real danger is in trying to superglue a cut that would heal better/quicker with stitches. WHEN IN DOUBT, CHECK WItH THE DR.

SCARS: All cuts/wounds WILL heal with a scar. No avaiding it, its the natural result of healing. Some scars will be so thin and small as to be impercepable, others will be massive. Some people naturally heal with thick raised scars (called keloids(, and others scar very little. To minimise a scar, the edges of the wound must be a close as possible to each other during healing, but without tension, difficult to achieve on a body part such as a finger than moves constantly all day. Avoid excessive use of a cut part, do not use the part forcefully, or anything else that causes tension on the skin of the wound.

TIME TO HEAL: this is different from the length of time the stitches stay in. Stitches are taken out as soon as possible to avoid causing more scaring, to limit allergic reactions (yes a lot of people are allergic to certain types of suture material), and to ease tension on the wound. The length of time a stitch is in place is determined by the depth of the wound and the location of the wound. This is out of your control, so won't go into a lot of detail about when to take them out. After the stitches are out, the wound needs to mature and fully heal to be as strong as it will get. Always ask your Dr about resuming specific activities (and be sure he/she understands what the activity entails as relates to the injured part), as this time will vary much like how long to leave a stitch in place. I cannot give a general time frame on this without knowing specifics of a particular wound, all wounds are different.

INFECTIONS: most are prevented by prompt and THOROUGH cleaning with mechanical removal of debris (wash and scrub) and covering with a sterile dressing (bandaid). Some redness is normal when a wound heals, but is limited to the edges of the wound. Redness extending outside the wound itself is possibly an infection, as is swelling of just the red areas. Wounds frequently secrete a small to moderate amount of tissue fluid which is normal. Normal oozing is a fluid that is the same as the liquid inside a blister: thin, clear, slightly yellow or clear, with no smell..this is ok. You all know what pus looks like, see your Dr. The wound should not feel warmer than surrounding areas to the touch..use the back of your hand to test for temperature, its much more sensitave to temperature than the palm side. The hallmarks of infection are redness, swelling, and heat... drainage may or may not be present, see the Dr if its hot r,ed and swollen.

OTHER IMPORTANT CONSIDERATIONS; A real danger of a cut on the hand or wrist is that there are numerous tendons just under the surface that are very easy to sever. Tendons connect muscle to bone, and are responsible for movement of a particular segment of bone. If you cut yourself, ALWAYS check to make sure that you can move the finger, wrist, hand, etc through EVERY SINGLE motion that it is capable of. If you cannot perform a motion that you could do before the injuty, YOU MUST SEE A HAND SURGEON ASAP. Delay in repairing severed tendons makes it either impossible to restore full function, or at best it takes much longer is makes it much more difficult to rehabilitate the injured part.

DISCLAIMER: this info is general in nature, and offered as advice from me to you to help you decide what to do when you are cut. All cuts and all people are different, so use your best judgment, and always WHEN IN DOUBT, SEEK MEDICAL ATTENTION, THE CONSEQUENCES MIGHT BE MORE SEVERE THAN YOU THINK.

I hope this is of a little help/interest, as we all will have a cut at some points, lets just pray they are small and insignificant. Safe carving to you all.
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Old 02-26-2010, 10:34 AM
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Default Re: First Aid for Cuts

Thanks for posting the info!

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Old 02-26-2010, 10:57 AM
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Default Re: First Aid for Cuts

yes thank you for the informtion. It could be very useful I have it committed to memory.
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Old 02-26-2010, 11:17 AM
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Default Re: First Aid for Cuts

Quote:
Originally Posted by SlowMover View Post
All creams (neosporin, polysporin, first aid creams, etc) are ok at first.
Not for everyone. I learned the hard way that I've developed an allergy to the "sporin" creams. I cut my finger with a steak knife doing dishes a few years ago and it was getting worse instead of better. I seriously thought I may lose the end of my left index finger it was so bad. My dermatologist took one look at it and said, "quit using Neosporin -- you're allergic to it". Wow...healed right up and haven't used the junk since.

Apparently it's a pretty common allergy, so if you ever notice you aren't healing correctly or a cut/wound is getting worse, consider the first aid cream as the issue.
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Old 02-26-2010, 11:23 AM
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Default Re: First Aid for Cuts

great advice-- it really boils down to common sense which so many of us fail to use regularly-- that does not any any way diminish the importance of what you have written- i for one intend to copy it and put near the medicine cabinet
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Old 02-26-2010, 12:38 PM
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Default Re: First Aid for Cuts

Michelle, I agree wholehearrtedly that allergy to Anything is a possibility. I didn't put in a caution after every product, but if you are allergic to any substance, or even to anything similar, please use caution in ingesting, inhaling, or touching a substance. Similarly, I didn't touch on associated medical conditions, so if you are on blood thinners, Aspirin, arthirits pills..be advised that they may increase your risk of bleeding longer than a person who isn't on these meds.

There are always exceptions to rules, please use your best judgment and don't ever take anything, even my words, as the absolute authority on anthing medical.
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Old 02-26-2010, 12:41 PM
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Default Re: First Aid for Cuts

I agree, SlowMover...I was just throwing out my personal experience. I just find more and more people allergic to the sporins and they had no idea. I find it very interesting so I tend to discuss it when it comes up.

Great info, though. It's interesting to me how such common sense gets thrown out the window when we see blood...especially our own.
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Old 02-26-2010, 01:36 PM
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Default Re: First Aid for Cuts

SlowMover,
Thank you for sharing all of the valuable info. Was a meat cutter for many years and know first hand how truly important this is:
A. Be careful using a knife
B. Know what to do if you mess up on A.
Thanks again,
Jim
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Old 02-26-2010, 01:46 PM
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Default Re: First Aid for Cuts

Hi Slo, Thanks for taking the time to post the info. It was good to read!
Carl
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Old 02-26-2010, 03:33 PM
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Default Re: First Aid for Cuts

Good info... any inputs on tetanus caused by old knives or metal blades? Are tetanus shots necessary after a cut?

Thanks

Ron
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