Used to be, good advice for this sort of thing was easy to find. Now the clinical advice is increasingly bad, according to my lived experience and observation of other people. What's worse, all kinds of advice in books, online, and from experts is now conflicting with each other. So here is a discussion of first aid for scrapes and cuts. It is based on awareness of how science works, rather than a medical profession. Use your judgment accordingly.( Read more... )
notes: "Having been undergoing fortnightly debridement and associated home wound care for over 2 years now I have learned to love 2% lidocane gel. I have determined that the household will not be without it. The brand I've been using is MPM Regenecare, same as used in the wound care office I go to, and it is available OTC. Also helps in cases of "picking the gravel out of road rash"!"
* For someone who tends to pick at injuries, it may be best to cover all of them completely, even if it wouldn't otherwise be necessary. If the wound needs air, you can always use a breathable bandaid or gauze. Picking tends to increase the risk of infection and scarring. (from mashfanficchick
)Spectrum of Injury
Amount of blood and pain do not always correlate to severity, although they do give some idea. Most scrapes, unless deep, don't bleed much; but certain areas, such as the head
, bleed more. Although typically shallow, scrapes tend to be quite painful because the wide surface area exposes many nerve endings
. However, severe abrasions may destroy so many nerves that the injury doesn't register much pain. Assess the whole injury carefully before making a plan.
Abrasions are similar to burns in regard to some aspects of skin destruction, and in fact the two injury types can overlap
in some cases such as road rash. Abrasions may be described as first, second, or third degree
depending on how deeply they damage the skin. They may also be rated minor, moderate, or major
based on size and other factors.
Here is a look at the range of damage commonly seen in abrasions:
* Clean scrapes that don't bleed,
like when you bump your knee under long pants. The top layer of skin comes off but that's all. Rinse with water, soap if you want some, and put lotion or cream on it to soothe the skin. It typically doesn't need antibiotic or a bandage, unless you're prone to infections.
* Ordinary scrapes that ooze blood
but have no visible debris and you didn't fall on anything filthy. Clean with water and mild soap, or a gentle wound rinse kind of antiseptic. I like Bactine, YMMV. Do check for grit that might have been hidden by blood at first. Top with your preferred first aid cream. I resent people dropping the original, which was a great product, and now there's nothing like it and ointments are NOT a synonym. Some people like triple-antibiotic ointments for scrapes, but I tend to reserve those for injuries that look prone to infection.
* Messy scrapes that bleed freely
and have some debris. Wash thoroughly in stages, using water and mild soap or antiseptic. By this point I am usually using alcohol or surgical disinfectant, because if I don't, I find that this type of injury tends to get infected. Remove as much grit as you can gently, but if you can't get it out gently, either be more assertive yourself or seek expert help. Be really careful with these injuries because it is easy to miss grit, and if you do, infection is almost guaranteed. Top with a good antibiotic cream or ointment, or a dressing that has similar effect -- the hydrogels are very good at suppressing infections and aiding recovery.
* Really ugly abrasions
like road rash and/or you fell on something filthy. Clean in stages as described above, but most people don't have the skill (or stomach) to handle these at home. A good first aid tent or emergency room comes with pain control for the unpleasant cleaning process! There they will use potent cleaners and scrub/pick vigorously, not just to remove debris but also skin damaged badly enough that it's going to die. This process is called debridement
, and has various options. That means if you're doing this at home, you also need medical scissors to snip off ragged ends. 0_o Top with hydrogel if at all possible; that seems to be widely acclaimed as the current best practice for severe abrasions.
* Deep abrasions with traumatic tattooing
drive particles far into the flesh. If not removed, this debris not only causes infection but also leaves permanent tattoo-like marks
in the skin. Aggressive treatment by a professional
is required for adequate cleaning. That means numbing the skin and then scrubbing it vigorously with surgical brushes and surgical soap. That will undoubtedly traumatize the flesh further, but gentle cleaning will not suffice for extreme cases and this is better than what happens if you leave a serious abrasion untreated. Various aftercare options are available to help the skin heal, but this type of extreme damage sometimes requires surgical intervention. If you cannot reach a medic quickly -- which often happens in wilderness injuries -- then clean as best you can using the steps described above for messy and ugly abrasions.Time to see an expert if at all feasible:
* Any skin damage bigger than about hand size, which is roughly 1% of your body mass. If assessing someone else, their hand is more accurate as a gauge of their body surface area, but they may not be willing or able to loan it to you whereas your own hands are usually available. People who routinely scuff large parts of their bodies may wish to set their own threshold higher or lower than this after observing how well they heal.
* Abrasions on delicate areas like the face or genitals.
* Abrasions that cover enough of a joint so you are worried about impeding motion. This means a tiny but nasty scrape may impair your finger knuckle, while it would take considerably more to affect your knee.
* There is debris and you can't get it all out or aren't sure if you did. Any remaining particles may cause traumatic tattooing
, which is worse with dark grit under pale skin.
* The abrasion doesn't hold its shape, related cuts won't stay closed, chunks of skin are actually missing, you can see fat or bone, bleeding won't stop after 10-20 minutes, any other sign the damage is deep or severe, etc.
* You fell on something filthy and haven't had a tetanus booster recently.
Balance the amount of damage against your personal first aid skills, how well your body heals, and the quality of available health care. Do you routinely collect scrapes, have complicating conditions, or treat someone else who does? If so, think about more advanced training than the rinse-and-wrap covered in basic first aid. Wilderness and sport classes
are worth considering. Bikers (motorcycle or mountain/dirt bike) often have specialized training for crash care
, which is an excellent place to learn about fixing bad abrasions such as road rash.Medium of Skin Products
First aid supplies come in a variety of formats. There is some overlap in what they treat, but they are NOT all interchangeable. I wrote a whole article on this topic once. Here's a thumbnail:Spray
is a liquid, often based in alcohol or water. There are some oil-based sprays but that's usually for things like bug repellent rather than skin care. Many wound rinses have antiseptic and analgesic ingredients in a bottle meant for spritzing or squirting over injuries. Plain water or irrigation saline solution may also work.Lotion
has more water than fat. It is light and gentle, easily spreading a long way. It doesn't clog up the skin. You can find a few varieties with antiseptic or antibiotic ingredients; they're not common and not a great idea for routine use, but help some rashes. Lotion soaks in rapidly and shouldn't leave the skin sticky, so it doesn't require a bandage. Many tattoo artists therefore prefer lotion or very light cream to heavier products for tending fresh ink, and that makes tattoo lotion a good choice for minor abrasions. Some of my well-inked friends have abandoned other first aid creams in favor of whatever their artist got them hooked on, and now that's what they put in their first aid kits.Cream
may have slightly more water than fat or about the same, and this is where waxes begin to appear as stiffening agents. Cream can be quite soft, just thick enough to stick on your finger, or stiff enough to stand up a bit if swept into peaks. It is gentle and very nourishing to skin, yet it can carry a mild to moderate dose of medication. It tends not to clog skin too much, but be a little careful if yours is prone to that. Cream is great for most scrapes and other minor injuries. A little will soak in, but a lot needs a bandages. Unfortunately this has become difficult to find as the market switched to ointments.Salve or ointment
is a thick, greasy material with more fat than water and uses wax to moderate texture. These tend to get very stiff and cold weather and may get runny in hot weather. They're prone to clogging the skin, worst of all if based in mineral oil and/or petroleum jelly; natural bases aren't quite as bad. They're also more uncomfortable to rub over injured skin and don't spread as far. However, they can carry a high dose of antibiotics or other medications which will then stay exactly where it is put. Salve may be useful for messy or dirty injuries where less assertive treatments might not be enough. It requires a bandage because it doesn't soak in much, and in fact, a thick coating of ointment is often used to keep bandages from sticking to a wound.Balm
is a semisolid stick that uses a lot of fat and wax to hold its shape, and a good one won't melt on you in summer. They carry medication moderately well. The stiff texture means it will go a very long way over minimally broken skin, which makes it ideal for the shallowest scrapes or scratches that bleed little if any. The same features make it unfeasible for use on messy scrapes -- it hurts like hell and doesn't adhere properly. My go-to item for scratches is a balm stick with tea tree and lavender essential oils as the active ingredients, and it makes a downright dramatic difference in how well they heal. Plus a balm stick leaves a thin film that absorbs well and doesn't get gunk everywhere or require a bandage. Rinse, swipe, and ignore.
>>Strangely we've found that leaving wounds mostly alone, ie not covering them after a day or so, works a lot better for healing than the "keep covered until healed" advice that people've usually seen.<<
Always prioritize your lived experience over other people's advice. Advice is good, science is good, but bodies aren't identical. I don't cover my dings unless they are messy or in an area I'll bump or rub against things. But I definitely notice they heal better if cleaned and treated with something. My favorite for scratches and shallow scrapes is actually a balm stick with tea tree and lavender.