Wounds & lacerations

Causes, bleeding, & care – when to go to the ER

1 in 5 US adults visit the emergency room each year.

However, you might not know when to go to the ER for a cut. After all, most cuts aren’t severe and heal properly with a first-aid kit.

A cut is a break or opening in the skin. It is also called a laceration. A cut may be deep, smooth, or jagged. It may be near the surface of the skin, or deeper. A deep cut can affect tendons, muscles, ligaments, nerves, blood vessels, or bone.

A puncture is a wound made by a pointed object such as a nail, knife, or sharp tooth. Puncture wounds often appear to be on the surface but may extend into the deeper tissue layers.

Common Causes of Cuts and Lacerations

• Blunt objects tear or crush the skin, commonly over bony areas like a finger, hand, foot, or knee.

• Sharp-edged objects press into and slice the skin, causing puncture wounds.

Follow this guide to know when to handle wound care on your own and when it’s time to go to the emergency room.

How to Manage on Your Own

Apply First Aid  
 
Most cuts are minor and respond well to home treatment. Apply first aid wearing medical gloves when possible. If medical gloves are not available and you must apply pressure, place something between your hands and the wound such as multiple layers of clean cloth, plastic bags, or the cleanest material available. 

Try to Stop the Bleeding 

• Use steady, direct pressure for at least 15 minutes – Time it and do not stop pressure to look at the wound.

• If the material becomes soaked, place more material on top, do not stop pressure.

• Elevate the cut above the heart if possible.

• If there is something in the wound, apply pressure on either side, not on top of the object.

Once the Bleeding Stops:

• Gently clean the wound with tap water and diluted antibacterial soap. Do not apply hydrogen peroxide, as this could damage the tissues.

• Apply antibiotic ointment and a bandage.

• Re-apply the ointment and a new bandage several times a day.

Monitor the wound 

• Monitor the wound and call your healthcare professional if you become concerned.

When to visit Virginia Mason Franciscan Health (VMFH) Emergency & Urgent Care

The bleeding won’t stop  
Try to stop the bleeding by applying pressure with a tissue, clean cloth or a gauze pad. If after 10 –15 minutes the bleeding does not stop, go to the emergency room.  You might need stitches to close the wound and stop the blood loss.

The wound shows signs of infection

Typical signs of infection are warmth, redness, pus discharge, pain, and fever. The doctor will treat the infected area properly before the infection spreads into deeper skin tissues.

The wound is not healing well 

There are many reasons a wound may not be healing well including pathogen exposure, dryness, medication, etc. If you feel like you’ve done everything needed to aid the healing process and it’s not improving, then it’s time to see a doctor.

The cut is too deep 

If the wound is exposing veins, muscles, and fat, it’s too deep for at-home care. These types of wounds have a high risk for complications, especially since deeper tissue is more easily exposed to external pollutants.

The cut is due to a rusty object 

Tetanus infections are a serious concern if the wound is due to a rusty object. Once tetanus bacteria enters a wound it can lead to complications such as seizures, muscle stiffness, fevers, and severe sweating. It’s critical to see a doctor before these symptoms start. Injuries from rusty or dirty objects may require a tetanus shot, antibiotics, and stitches.

Other types of wounds requiring an immediate visit to the ER 

• Visible dermis or yellow layer of fatty tissue (subcutaneous tissue) or wounds over a possible broken bone.

• Tip of finger or toe cut off.

• Split or gaping open so gentle pressure can’t keep the edges together.

• Foreign objects sticking through the skin. Do NOT remove any foreign object.

• Human or animal bites 

• A high-pressure impact wound from a bullet or other projectile.

• A cut over a joint – possible damage to nerves, ligaments, or tendons.

• Severe, profuse, or copious bleeding.

• A cut or laceration or near the genitalia.

• A cut or laceration on the face or another area where you want to minimize the scarring.

CAUTION: If there is severe swelling or bruising beginning within 30 minutes of an injury, it could signal serious bleeding or damage to the deep tissues.

TIP: If you believe a child may require stitches, withhold food and drink before going to the emergency room. The child may need to be sedated, and eating and drinking can delay treatment.

If you think you or a family member has suffered a wound that requires emergency care, call 911 or visit VMFH Emergency & Urgent Care. Our staff is fully equipped with on-site labs, X-rays, ultrasound and CT scans, all under one roof.