The Medical Minute: First aid basics for bruising and bleeding

August 21, 2003

By John Messmer, M.D.
Penn State Milton S. Hershey Medical Center

Bruises, cuts and scrapes -- they happen to us and our children. When we get the occasional bruise, cut or scrape we need to know what is the best treatment for these injuries and when to call the doctor.

Bruises

A bruise occurs when trauma does not open the skin but breaks tiny blood vessels called capillaries. Blood leaking into the skin causes the black and blue discoloration. If ice or a cold pack is available, apply it to the injured area for 10-15 minutes at a time over the next hour or two to constrict the capillaries and limit the bruising and swelling. Even people on anticoagulants can limit a bruise this way. Ice may be continued if the area is still painful. For large bruises, especially of the face, or if the swelling limits the use of a joint, consult your doctor within 24 hours. A bruise near the eye that affects vision should be evaluated by a physician that day.

Some people seem to bruise easily. When bruises are small -- less than the size of a quarter -- and limited to a few areas on the body, they usually are not serious. The skin of older people has lost its supporting tissue and is more easily traumatized. Superficial bruises up to a couple inches in diameter occur with minimal trauma, particularly on the arms. These do not require special treatment unless the skin is broken.

Large areas of blue or purple discoloration or swelling, especially if there is no apparent reason, should prompt a call to the doctor. Those on anticoagulants may bruise more easily, but large bruises may result from too much anticoagulant medication.

Cuts and scrapes

When the skin is broken, bacteria may enter and cause infection and bleeding can be more severe. If the wound is large or deep enough, it can take longer to heal and may affect the function of the area.

The first treatment to any wound is to apply pressure directly onto the bleeding site. While a clean or sterile cloth would be ideal, you can use your bare hand if dressings are not readily available. If bleeding is brisk and particularly if it is squirting out, direct pressure is essential. Do not allow the wound to bleed to "clean it out." It is a misconception to think bleeding cleans a wound.

Wash the area with soap and water, even if it is still bleeding a bit. Do not use peroxide, alcohol or bleach -- since they will damage the healthy skin. Peroxide is used to clean infectious drainage from wounds and abscesses but has no use in cleaning a fresh wound. If dirt, a splinter or foreign material such as road grit is in the wound, tweezers may be needed. Any remaining foreign material impairs healing and increases the risk of infection. If you can not completely clean it, call your doctor.

If bleeding has not stopped by the time the wound is clean or if it resumes, apply direct pressure again with clean gauze or a clean cloth. Simply wrapping it in a bandage is not usually enough pressure. Five minutes of pressure should stop the bleeding. If not, contact your doctor. If bleeding is stopped and the wound is cleaned and covered with a sterile dressing, you need not go to the emergency room. Even if you anticipate it might need stitches, a properly cleaned wound can usually wait until morning.

A doctor should evaluate wounds that gape open, are irregular or have large flaps, have visible fat, that cross joints or involve the face or genitals. A wound that has been thoroughly cleaned and is free of foreign material should not need antiseptic. Mercurochrome, merthiolate and pure iodine are toxic to healthy tissue and should not be used.

There is disagreement as to whether antiseptic ointments have benefit. Healing is better when there is just the right amount of moisture -- too much and infection is more likely. A simple straight cut that has been cleaned and covered probably does not need antiseptic ointments. Because an abrasion has a larger area to grow new skin, it might heal better with a thin layer of antibiotic ointment.

A tetanus booster is sometimes needed. Rust does not cause tetanus. Tetanus germs live in the soil so for puncture wounds or those contaminated with soil, a booster is needed if it has been five years since the last tetanus shot; otherwise 10 years is the usual interval for a booster.

With the exception of most bug bites, all bites should be seen by a doctor, particularly human bites or any bite on the hand or fingers. These usually require antibiotics prophylactically. Cuts contaminated with someone else's blood should prompt a medical evaluation. Diabetics or anyone with poor circulation with cuts or scrapes on the feet may follow the above advice but should see their doctor within a day or two of the injury for an evaluation.

As your wound is healing, wash it daily unless your doctor tells you otherwise. If a cut or scrape gets progressively more swollen or painful, gets very red or drains pus, it may be infected and should be seen by a doctor.

You will be prepared if you stock your home first aid kit with a small bar of soap, a variety of adhesive bandages, some sterile gauze, tape, scissors and a small tube of antibiotic ointment. Self-activating ice packs are also a handy item as are butterfly closures. A little preparation now can help out later.

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Last Updated March 20, 2009