Skin Injury (Cuts, Scrapes, Bruises)

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DEFINITION

• Cuts, lacerations, gashes and tears
• Scrapes, abrasions, scratches and floor burns
• Bruises (bleeding into the skin) without an overlying cut or abrasion

When Sutures (stitches) are Needed

• Any cut that is split open or gaping probably needs sutures.
• Cuts longer than ½ inch (12 mm) usually need sutures.
• On the face, cuts longer than ¼ inch (6 mm) need sutures.
• Any open wound that may need sutures should be checked and closed within 6 hours if possible. There is no cutoff, however, for treating open wounds to prevent wound infections . 

See More Appropriate Topic (instead of this one) If

• It's a puncture, see PUNCTURE WOUND
• There's a sliver in the skin, see SPLINTER OR SLIVER
• Injury looks infected, see WOUND INFECTION

FIRST AID Advice for Bleeding:

• Apply direct pressure to the entire wound with a clean cloth.

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WHEN TO CALL YOUR DOCTOR

Call 911 Now (your child may need an ambulance) If

• Major bleeding that can't be stopped (see FIRST AID)

Call Your Doctor Now (night or day) If

• For bleeding, see FIRST AID
• You think your child has a serious injury
• Bleeding won't stop after 10 minutes of direct pressure 
• Deep cut and can see bone or tendons
• Skin is split open or gaping especially on the face
• Age under 1 year old
• Dirt or grime in the wound is not removed after 15 minutes of scrubbing
• Wringer-type injury 
• Skin loss from bad scrape goes very deep
• Skin loss involves greater than 10% of body surface (Note: The palm of the hand equals 1%)
• Cut or scrape looks infected (redness, red streak or pus)

Call Your Doctor Within 24 Hours (between 9am and 4pm) If

• You think your child needs to be seen
• Several bruises occur without any known injury
• Very large bruise follows a minor injury

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns
• No tetanus shot in over 10 years (5 years for dirty cuts at higher risk for tetanus)
• Doesn't heal within 10 days

Parent Care at Home If

• Minor cut, scrape or bruise and you don't think your child needs to be seen

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HOME CARE ADVICE FOR MINOR BRUISES, CUTS AND SCRAPES

1. Bruises:
   • Apply a cold pack or ice bag wrapped in a wet cloth to the bruise once for 20 minutes to stop the bleeding.
   • After 48 hours apply a warm wet wash cloth for 10 minutes 3 times per day to help reabsorb the blood.
2. Cuts, Scratches and Scrapes
   • Apply direct pressure for 10 minutes to stop any bleeding.
   • Wash the wound with soap and water for 5 minutes. (Caution: never soak a wound that might need sutures, because it may become more swollen and difficult to close.)
   • Gently scrub out any dirt with a washcloth.
   • Cut off any pieces of loose skin using a fine scissors (cleaned with rubbing alcohol).
   • Apply an antibiotic ointment, covered by a Band-Aid or dressing. Change daily.
3. Liquid Skin Bandage for Minor Cuts and Scrapes:
   • Liquid skin bandage is a new product that seals wounds with a plastic coating that lasts up to 1 week.
   • Liquid skin bandage has several benefits when compared to a regular bandage (eg. 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. It’s resistant to bathing.
   • This new product is available at your local pharmacy.
4. Pain Medicine: Give acetaminophen (e.g. Tylenol) or ibuprofen as needed for pain relief.
5. Call Your Doctor If:
   • Looks infected (pus, redness, increasing tenderness)
   • Doesn't heal within 10 days
   • Your child becomes worse 

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