Basic First Aid and Street Medics

First Aid for Cuts, Scrapes, Puncture Wounds At A Glance

Washing a cut or scrape with soap and water and keeping it clean and dry is all that is required to care for most wounds. Putting alcohol, hydrogen peroxide, and iodine into a wound can delay healing and should be avoided. Seek medical care early if you think that you might need stitches. Any delay can increase the rate of wound infection. Any puncture wound through tennis shoes has a high risk of infection and should be seen by your healthcare professional. Any redness, swelling, increased pain, or pus draining from the wound may indicate an infection that requires professional care.

What is the best way to care for a cut or scrape?

The most important first step is to thoroughly clean the wound with soap and water being careful to remove any foreign material, such as dirt or bits of grass, that might be in the wound and which can lead to infection. The area should then be kept clean and dry.

Covering the area with a bandage (such as gauze or a band-aid) helps prevent infection and dirt from getting in the wound. A first aid ointment, such as BACITRACIN, can be applied to help prevent infection. Generally, however, these products are best avoided on the hands and feet beyond the first day because they can delay healing in these areas.

Continued care to the wound is also important. Washing the area gently with soap and water daily without scrubbing is best as the wound heals.

Avoid putting products such as hydrogen peroxide, alcohol, or iodine solutions in the wound. These only delay wound healing and do not do anything to prevent infection.

Who should seek medical care for a cut?

People who have diabetes, other long-term illnesses such as cancer, or are taking drugs that suppress the immune system such as steroids (cortisone medications like prednisone and prednisolone) or chemotherapy, are more likely to develop a wound infection and should be seen by a health care professional.

Any cut that goes beyond the top layer of skin that might need stitches (sutures) should be seen by a health care professional. Generally, the sooner sutures are put in, the lower the risk of infection. Therefore, any cut that might need suturing should be seen as soon as possible.

What are the signs of a wound infection?

If the wound begins to drain greenish fluid (pus) or if the skin around the wound becomes red, warm, swollen, or increasingly painful, a wound infection may be present and medical care should be sought.

Any red streaking of the skin around the wound may indicate an infection in the system that drains fluid from the tissues, called the lymph system. This infection (lymphangitis) can be serious, especially if it is accompanied by a fever. Prompt medical care should be sought if streaking redness from a wound is noticed.

How are puncture wounds different?

There are two risks with puncture wounds. First, a wound infection can occur because of dirt pushed deep into the skin by the object (typically a nail)puncturing the tissue. As you can imagine, these wounds are very difficult to clean out. The second problem that can occur is an infection of the bone. If a nail penetrates deep into the foot, it can hit a bone and introduce bacteria into the bone. This risk is especially great if the nail has gone through a pair of tennis shoes. The foam in tennis shoes can harbor a bacteria (Pseudomonas) that can lead to serious infection in the tissues.

First aid for puncture wounds includes cleaning the area well and keeping the foot elevated for several days (depending on the severity of the puncture wound). Especially if the puncture wound occurred through tennis shoes, an evaluation by a healthcare professional should be sought. Additionally, diabetics, the elderly, those persons taking drugs that can suppress the immune system (such as cortisone-related medications), or any particularly deep puncture wound should be seen by a healthcare professional. This is particularly true if it was difficult to remove the nail, indicating that it may have penetrated the bone. Most puncture wounds do not become infected, but if redness and swelling persist, see your health care professional.

Puncture wounds commonly occur when someone steps on a nail. It is a good idea to wear shoes to minimize the risk of a puncture wound, especially if you have diabetes or loss of sensation in the feet for any reason.

Will I need a tetanus shot?

Most people in the United States have been immunized against tetanus (lockjaw). If you have been immunized, you will need a booster shot if you have not had one in over five years. If you have never had a tetanus shot, or if your series is incomplete (fewer than 3 shots), you might need tetanus immunoglobulin, a medication that can prevent lockjaw.