Puncture Wounds
Topic OverviewCauses of puncture woundsA
puncture wound is a forceful injury caused by a sharp, pointed object that
penetrates the skin. A puncture wound is usually narrower and deeper than a cut
or scrape. Many people accidentally get puncture wounds with household or work
items, yard tools, or when operating machinery. Most puncture wounds are minor,
and home treatment is usually all that is needed. Sharp objects,
such as nails, tacks, ice picks, knives, teeth, and needles, can all cause
puncture wounds. Puncture wounds increase your risk of infection because they
are hard to clean and provide a warm, moist place for bacteria to
grow. The bacteria Pseudomonas are a common cause of infections when a puncture wound occurs through the sole of an athletic shoe. Some punctures are done for
health reasons. For example, a puncture may be used by
a doctor to draw blood or to give fluid or medicines directly into a vein
(intravenous, or IV). Health professionals
have an increased risk of needle-stick injuries. A puncture from a used needle
increases the risk of infection or for transmitting a blood-borne disease, such
as
hepatitis or
human immunodeficiency virus (HIV). Home treatment may
be all that is needed for puncture wounds from clean needles. What to do if you get a puncture wound?When
you have a puncture wound: - Determine if any part of the object that
caused the wound is still in the wound, such as a splinter or
lead (graphite) from a pencil. A pencil
lead puncture wound is less worrisome, so it is not
necessary to check blood levels for lead or worry about lead toxicity or
poisoning.
- Determine
if underlying tissues, such as blood vessels, nerves, tendons, ligaments,
bones, joints, or internal organs, have been injured by the
object.
- Clean the wound and remove any dirt or debris to prevent
infections, both
bacterial skin infections and
tetanus ("lockjaw").
- Determine whether you
need a
tetanus shot.
Check your symptoms to decide if and when you
should see a doctor. Check Your SymptomsDo you have a puncture wound? This is a wound caused by a sharp, pointed object going through the skin. Puncture wounds are deeper and narrower than cuts. How old are you? Less than 12 years Less than 12 years 12 years or older 12 years or older Do you have an eye injury? Do you have an injury caused by a fishhook? Do you have a deep wound in your head, neck, chest, or belly? A deep puncture wound in any of these areas could damage the internal organs. Yes Deep puncture wound to head, neck, chest, or belly No Deep puncture wound to head, neck, chest, or belly Are you having trouble breathing (more than a stuffy nose)? Yes Difficulty breathing more than a stuffy nose No Difficulty breathing more than a stuffy nose How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine? 8 to 10: Severe pain Severe pain 5 to 7: Moderate pain Moderate pain 1 to 4: Mild pain Mild pain Has the pain lasted for more than 8 hours? Yes Pain for more than 8 hours No Pain for more than 8 hours Is the pain getting worse? Have you been injected with something under high pressure, like oil or paint from a sprayer? Yes Injection under high pressure No Injection under high pressure Is there a deep puncture in or over a joint? A puncture that goes into a joint can be serious. Yes Deep puncture in joint area No Deep puncture in joint area Do you have a wound on your arm, leg, hand, or foot that is more than just a scratch? For an arm or leg wound, is the skin below the wound (farther down the limb) blue, pale, or cold to the touch and different from the other arm or leg? This may mean that a major blood vessel was damaged and that blood is not reaching the rest of the arm or leg. Yes Skin is blue, pale, or cold below an arm or leg injury No Skin is blue, pale, or cold below an arm or leg injury Can you move the area below the injury normally, even though it may hurt? Yes Able to move limb normally below injury No Unable to move limb normally below injury For an arm or leg wound, is there any numbness, tingling, or loss of feeling around the wound or below the wound (farther down the arm or leg)? This may mean that a nerve was damaged. Yes Numbness, tingling, or loss of feeling around or below an arm or leg injury No Numbness, tingling, or loss of feeling around or below an arm or leg injury Do you think you may have a fever? Are there red streaks leading away from the area or pus draining from it? Do you have diabetes, a weakened immune system, peripheral arterial disease, or any surgical hardware in the area? "Hardware" includes things like artificial joints, plates or screws, catheters, and medicine pumps. Yes Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area No Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area Have you been stuck with a used or dirty needle? Yes Stuck with used or dirty needle No Stuck with used or dirty needle Is there an object stuck in the wound, and you can't get it out? You may not be able to remove it because of where or how deep the wound is or because it causes severe pain. Is the object large or small? Large means things like a nail or piece of wood that is at least 2 in. (5.1 cm) long and anything bigger than that. Small means things like a pencil tip or a small splinter or sliver. Large Large embedded object Small Small embedded object Did you have swelling or bruising within 30 minutes of the injury? Yes Swelling or bruising within 30 minutes of injury No Swelling or bruising within 30 minutes of injury Has the swelling or bruising raised a lump that's more than about 1.5 in. (4 cm) across or deep? This would be bigger than a golf ball or Ping-Pong ball. Yes Lump bigger than golf ball or Ping-Pong ball No Lump bigger than golf ball or Ping-Pong ball Do you have a puncture wound in your foot? Yes Puncture wound in foot Did the object go through a shoe or boot? An object that has enough force behind it to go through a shoe can cause serious injury to the foot. Puncture wounds in the sole of the foot also have a high risk of infection. Yes Object went through a shoe or boot No Object went through a shoe or boot Many things can affect how your body responds to a symptom and what kind
of care you may need. These include: - Your age. Babies and older
adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart
disease, you may need to pay closer attention to certain symptoms and seek care
sooner.
- Medicines you take. Certain
medicines, herbal remedies, and supplements can cause symptoms or make them
worse.
- Recent health events, such as surgery
or injury. These kinds of events can cause symptoms afterwards or make them
more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug
use, sexual history, and travel.
Try Home TreatmentYou have answered all the questions. Based on your answers, you may be
able to take care of this problem at home. - Try home treatment to relieve the
symptoms.
- Call your doctor if symptoms get worse or you have any
concerns (for example, if symptoms are not getting better as you would expect).
You may need care sooner.
Symptoms of infection may
include: - Increased pain, swelling, warmth, or redness in or
around the area.
- Red streaks leading from the area.
- Pus draining from the area.
- A fever.
Pain in adults and older children - Severe pain (8 to 10): The pain
is so bad that you can't stand it for more than a few hours, can't sleep, and
can't do anything else except focus on the pain.
- Moderate pain (5 to 7): The pain is bad enough to disrupt your
normal activities and your sleep, but you can tolerate it for hours or days.
Moderate can also mean pain that comes and goes even if it's severe when it's
there.
- Mild pain (1 to 4): You notice the pain,
but it is not bad enough to disrupt your sleep or activities.
Pain in children under 3 years It can be hard to tell how much pain a baby or toddler is in. - Severe pain (8 to 10): The
pain is so bad that the baby cannot sleep, cannot get comfortable, and cries
constantly no matter what you do. The baby may kick, make fists, or
grimace.
- Moderate pain (5 to 7): The baby is
very fussy, clings to you a lot, and may have trouble sleeping but responds
when you try to comfort him or her.
- Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds
when you try to comfort him or her.
Certain health conditions and medicines weaken the immune system's ability to fight off infection and
illness. Some examples in adults are: - Diseases such as diabetes, cancer, heart disease,
and HIV/AIDS.
- Long-term alcohol and drug
problems.
- Steroid medicines, which may be used to treat a variety
of conditions.
- Chemotherapy and radiation therapy for
cancer.
- Other medicines used to treat autoimmune
disease.
- Medicines taken after organ transplant.
- Not
having a spleen.
With severe bleeding, any of these may
be true: - Blood is pumping from the wound.
- The
bleeding does not stop or slow down with pressure.
- Blood is quickly soaking through bandage after bandage.
With moderate bleeding, any of these may
be true: - The bleeding slows or stops with pressure but
starts again if you remove the pressure.
- The blood may soak through
a few bandages, but it is not fast or out of control.
With mild bleeding, any of these may be
true: - The bleeding stops on its own or with
pressure.
- The bleeding stops or slows to an ooze or trickle after
15 minutes of pressure. It may ooze or trickle for up to 45 minutes.
You may need a tetanus shot depending
on how dirty the wound is and how long it has been since your last shot. - For a dirty wound that has
things like dirt, saliva, or feces in it, you may need a shot if:
- You haven't had a tetanus shot in the past 5
years.
- You don't know when your last shot was.
- For a clean wound, you may
need a shot if:
- You have not had a tetanus shot in the past 10
years.
- You don't know when your last shot was.
Symptoms of difficulty breathing can range from mild to severe. For example: - You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).
- It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you’re at rest (severe difficulty breathing).
Seek Care TodayBased on your answers, you may need care soon. The
problem probably will not get better without medical care. - Call your doctor today to discuss the symptoms
and arrange for care.
- If you cannot reach your doctor or you don't
have one, seek care today.
- If it is evening, watch the symptoms and
seek care in the morning.
- If the symptoms get worse, seek care
sooner.
Seek Care NowBased on your answers, you may need care right away. The problem is likely to get worse without medical care. - Call your doctor now to discuss the symptoms and
arrange for care.
- If you cannot reach your doctor or you don't have
one, seek care in the next hour.
- You do not need to call an
ambulance unless:
- You cannot travel safely either by driving
yourself or by having someone else drive you.
- You are in an area
where heavy traffic or other problems may slow you down.
Call 911 NowBased on your answers, you need
emergency care. Call911or other emergency services now. Call 911 NowBased on your answers, you need
emergency care. Call911or other emergency services now. Put direct, steady pressure on the
wound until help arrives. Keep the area raised if you can. Eye Injuries Fishhook Injuries Home TreatmentMinor puncture wounds can be
treated effectively at home. If you do not have an increased risk of
infection, you do not have other injuries, and you do not need a tetanus shot or treatment by a
doctor, you can treat a puncture wound at home. Home
treatment can prevent infection and promote healing. The American Red Cross recommends that everyone use blood and body fluid precautions with first aid treatment. Remove object- Make sure the object causing the wound is not
still in the wound. Check to see if the object is intact and a piece has not
broken off in the wound.
- Try to remove the object that caused the
wound if it is small and you can see it. If you have a splinter, try using
cellophane tape before using clean tweezers or a needle. Simply put the tape
over the splinter, then pull the tape off. The splinter usually sticks to the
tape and is removed painlessly and easily. Be careful, and do not push the
object farther into the wound. Do not wet the splinter.
Stop the bleeding- Allow the wound to bleed freely for up to 5
minutes to clean itself out, unless there has been a lot of blood loss or blood
is squirting out of the wound.
- Stop the bleeding with direct
pressure to the wound.
After you have stopped the bleeding, check your
symptoms to determine if and when you need to see your
doctor. Clean the woundClean the wound as soon as possible
to reduce the chance of infection, scarring, and tattooing of the skin from
dirt left in the wound. (If dirt or other debris is not removed from a puncture
wound, the new skin will heal over it. The dirt can then be seen through the
skin and may look like a tattoo.) - Wash the wound for 5 minutes with large
amounts of cool water and soap (mild dishwashing soap, such as Ivory, works
well). Some nonprescription products are available for wound
cleaning that numb the area so cleaning doesn't hurt as much. Be sure to read
the product label for correct use.
- Do not use rubbing alcohol,
hydrogen peroxide, iodine, or Mercurochrome, which can harm the tissue and slow
healing.
Consider applying a bandageMost puncture wounds heal
well and don't need a bandage. You may need to protect the puncture wound from
dirt and irritation. Be sure to clean the wound thoroughly before
bandaging it to reduce the risk of infection occurring under the bandage. Puncture wounds are less likely than cuts to need stitches, staples or skin adhesives. Tetanus- Determine whether you need a
tetanus shot.
- You may have a localized
reaction to a tetanus shot. Symptoms include warmth, swelling, and redness at
the injection site. A mild fever may occur. Home
treatment can help reduce the discomfort.
Pain reliefElevate the injured area on pillows anytime you are sitting or lying down. Try to keep the
area at or above the level of your heart to reduce swelling. Medicine you can buy without a prescription Try a nonprescription
medicine to help treat your fever or pain: |
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Talk to your child's doctor before switching back and
forth between doses of acetaminophen and ibuprofen. When you switch between two
medicines, there is a chance your child will get too much medicine. | Safety tips Be sure to follow
these safety tips when you use a nonprescription medicine: |
---|
- Carefully read and follow all
directions on the medicine bottle and box.
- Do not take more than
the recommended dose.
- Do not take a medicine if you have had an
allergic reaction to it in the past.
- If
you have been told to avoid a medicine, call your doctor before you take
it.
- If you are or could be pregnant, do not take any medicine other
than acetaminophen unless your doctor has told you to.
- Do not give aspirin to anyone younger than age 20 unless your doctor tells you to.
| Symptoms to watch for during home treatmentCall your doctor if any of the following occur during home
treatment: - Signs of infection
- Signs of
loss of function
- Signs of decreased blood flow
- Pain
gets worse.
- Symptoms become
more severe or more frequent.
PreventionTo prevent puncture wounds, be sure to practice safety when using blunt or sharp objects. - Pay close attention to what you are
doing.
- If you become distracted, set the object aside until you can
pay attention to what you are doing.
- Know how to use the object
properly.
- Have good lighting so you can see what you are
doing.
- Wear gloves whenever possible to protect your
hands.
- Wear other safety gear, such as glasses or boots, as
appropriate.
- Hold a sharp object away from your body while using
it.
- Carry the object with the dangerous end away from
you.
- Shut the power off and use safety locks on your power tools
when you are not using them.
- Be very careful when using
high-pressure equipment, such as staple guns or paint sprayers. Make sure your
work area is clear of people and hazards that could interfere with the safe
operation of the equipment.
- Store dangerous objects in secure
places away from children.
- Teach children about safety, and be a
good role model.
- Do not use alcohol or drugs when you are handling
sharp objects.
Be sure to have a tetanus shot every 10 years. Preparing For Your AppointmentTo prepare for your appointment, see the topic Making the Most of Your Appointment. Questions to prepare for your appointmentYou can help your
doctor diagnose and treat your condition by being prepared to answer the
following questions: - What are your main symptoms? How long have you
had your symptoms?
- How and when did the puncture wound occur? Have
you had any injuries in the past to the same area? Do you have any continuing
problems because of the previous injury?
- What object caused the
puncture wound? Was there or is there an object in the puncture wound? Was the
object removed in one piece? Did the injury occur under high
pressure?
- What home treatment measures have you tried? Did they
help?
- What nonprescription medicines have you tried? Did they
help?
- What prescription and nonprescription medicine do you
take?
- Were drugs or alcohol involved in your
injury?
- When was your last
tetanus shot?
- Do you have any
health risks?
CreditsByHealthwise Staff Primary Medical ReviewerWilliam H. Blahd, Jr., MD, FACEP - Emergency Medicine Specialist Medical ReviewerH. Michael O'Connor, MD - Emergency Medicine Martin J. Gabica, MD - Family Medicine Current as ofMarch 20, 2017 Current as of:
March 20, 2017 Last modified on: 8 September 2017
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