From Abrasions to Lacerations

23 August 2011 By Robb Leigh, MD, MBA, CTH, CPE and Chief Medical Officer, MedAire

People fall, they slip, they trip and these incidents may result in an injury. In order to keep your guests’ vacation sailing smoothly, knowing how to properly treat an onboard injury such as a cut, scrape or puncture and knowing how to prevent infection and further injury are paramount.

Remember, whenever dealing with bodily fluids, always wear gloves and remain vigilant.

Abrasions (scrapes), lacerations (cuts) and punctures come in all shapes and sizes from common activities, including: running, walking, slipping, tripping or falling. A myriad issues can result when trying to brace the fall — including bruising and/or breaking open the skin. Though swimming and diving are seemingly harmless activities, scrapes, cuts and punctures often are the result of grazing fire coral or stepping on a sea urchin. Lack of attention and caution when using jet skis and other water toys can lead to accidental injury.

An abrasion occurs when the top layer of skin is scraped off. It often results in pain, swelling and minimal bleeding and is contaminated with dirt or gravel.

A laceration is a cut through the skin. It often results in pain and bleeding as well as possible tendon or never injury. Sometimes a foreign body may remain in the wound.

A puncture is a narrow opening caused by a nail or other object that deeply penetrates the skin. It often results in pain, swelling and bruising. Punctures are extremely susceptible to infection.

Signs and symptoms of infection to watch for:
•Tenderness and reddening of the skin,
•Warmth, and swelling, which suggest infection that, when advanced, could turn into an abscess (pus pocket)
•Lymphangitis – red streaks that start near the area of redness that travels upstream indicate there is an infection traveling in the lymphatic vessel
•Fever and chills, which indicate infection is spreading to other body areas
•Pain that does not match the size of the injury, usually signals infection of deeper tissue.

Because skin is a natural barrier against infection, once there is an opening in the skin, the door is open for opportunistic agents (bacteria or parasites) to enter the body.  

To prevent infection, thoroughly clean the wound with gentle soap and fresh water.

Cuts don’t necessarily need to be sutured (stitched) immediately. The initial attention is always to control bleeding with direct pressure.

To determine if sutures are required you must look at:
•Location – Facial cuts should be sutured (by an experienced doctor) whenever possible due to cosmetic reasons. Therefore, it is frequently recommended to postpone stitching up to a reasonable time frame (12 to 18 hours) until a qualified medical professional is available.
•Tension – Cuts in areas normally subjected to tension or stretching (e.g., dorsal areas of hands, extending areas of elbows, front areas of knees and neck) may require sutures, as tension will cause the skin to easily open up without them.
•Depth – Deep cuts heal faster with sutures.
•Length – Longer cuts tend to open up in the center without a proper closure.
•Cleanliness – Dirty wounds should never be stitched, as infection will surely develop.

Minor injuries are not big deal, when the proper precautions are taken. Knowing how to deal with cuts, scrapes and punctures can keep your guests healthy and happily enjoying their vacation.  

Dr. Robb Leigh is a practicing emergency physician at a Level I Trauma Center, and is the Chief Medical Officer for MedAire, Inc. At MedAire’s MedLink Global Response Center, Dr. Leigh provides medical advice for maritime crew living and working away from professional medical care.

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