Each year, over 130 million Americans visit the emergency room at hospitals throughout the country. One in 5 of these visits involves an injury, such as an open wound.
Open wounds include lacerations (cuts), abrasions, burns, and avulsion — tearing of skin and the tissue underneath. These wounds are often the result of falls, accidents with sharp objects and motor vehicle accidents that cause the skin to be cut, torn or punctured.
Dr. Richard Tempel, emergency care physician at Orlando Health, shares information on how wounds are treated in the ER, how to care for your wound at home and signs of infection to look out for.
A lot of wounds can be treated at home with a regular old first aid kit. It’s amazing what a single bandaid can do, but sometimes there are reasons to visit the ER instead.
Wounds worth an ER visit
- Severe bleeding
- Bleeding that persists for more than 10 minutes after applying pressure
- Any animal bite that punctures the skin
- A cut or puncture that is more than a quarter-inch deep
- Loss of mobility due to the injury
- Skin puncture from a dirty or rusty object
- Facial wound
- A wound with jagged edges or edges that are far apart and will not be able to close on its own
If you have diabetes or another chronic health condition, you may be more likely to get an infection, so you should go to the ER right away to prevent more serious concerns from developing, according to Dr. Tempel.
Triage in the ER: What to expect
Once you arrive at the ER, you will enter triage. This is where staff will assess your injury and ask questions about your medical history to determine if your wound can be treated in the ER.
Different injuries require different types of interventions. The ER staff will find the best way to close the wound to prevent infection and reduce scarring. Depending on the severity and location of the wound, you may need to be transferred to the operating room for surgery or admitted to the hospital for intravenous fluids and antibiotics.
If your wound can be treated in the ER, doctors and nurses will follow certain steps to minimize your pain, prevent infection and restore normal function of the injured body part. They might:
Numb the area. Topical and injectable local anesthetics are commonly used to numb the area around the wound and reduce your pain while the wound is being treated. A nerve block or sedation may be used for people who are experiencing intense pain.
Clean the affected area. One of the most important parts of treating a wound is cleansing the area and removing any dirt or debris to prevent infection. ER staff may use alcohol, iodine or saline to properly wash and sterilize the wound.
Wound repair. Depending on the location and type of injury, your wound may need to be closed using skin glue, staples, Steri-Strips (butterfly stitches), or sutures (stitches).
Wound dressing. There are many ways to bandage a wound. Simple wounds may be left uncovered to help them dry and heal. Others will need to be kept moist and covered for several days while they heal.
Antibiotics. You may be prescribed topical or oral antibiotics if your wound is at a high risk of becoming infected, such as if it’s a puncture wound, or you have a history of MRSA infection.
Tetanus shot. If you have an animal bite, puncture wound, or a burn that damages a lot of tissue, you may need a tetanus booster shot to prevent an infection.
You’re leaving the ER. Now what?
Before you leave the ER, your doctor will give you verbal and written discharge instructions on how to care for your wound at home and signs of infection to watch out for. The instructions will include information on:
- How to keep your wound covered
- How often to change the bandage
- How to clean your wound
- How to use topical antibiotics to prevent infection
- When to get sutures/staples removed, if needed
Instructions may also include the following guidelines, depending on the severity and type of wound:
- No swimming or bathing for 24 hours.
- Keep the wound clean and dry for 5 days, unless instructed otherwise.
- Do not go into a lake, river or ocean for at least 2 to 3 days due to the risk of bacteria entering the wound.
- Take the full course of antibiotics as directed.
- Take over-the-counter pain relief medication or prescribed pain medication as directed.
Follow the instructions carefully to reduce the risk of infection, minimize scarring and promote healing. The ER doctor may recommend follow-up with your primary care physician or a wound specialist to make sure the wound is healing and look for signs of infection.
See these signs? See the doctor
Your wound should gradually heal over time. If it begins to feel or look worse, it’s important to see your doctor since infected wounds can lead to serious complications. Signs of infection to watch out for include:
- Redness or swelling around the wound
- Heat around the wound
- Red streaks in the area around the wound
- Oozing yellow or green pus — clear fluid is normal
- Fever and/or body aches
Watch your wound closely and see your doctor if you are not getting better as expected.