Big cuts that need stitches....do you bandage it with pressure or without?

[Matthew99]

Say someone got a relatively deep cut that probably need stitches, and let's say there isn't much bleeding. Do you bandage it hard and strong or do you just bandage it to cover it?

I would imagine that the hospital would want the skin to stay separated if they're anyway gonna stitch it, no? So if it's not bleeding, there's no real need to apply a bandage that creates pressure on the cut?

[ERDoc]

Put it however you want it, just don't cut off circulation. We're going to take the bandages off and look at it either way. Unless you have a 24 hour transport time, the wound will not start to heal in the time that you are transporting.

[Matthew99]

So in other words "it doesn't matter how you bandage it as long as the bandage stay on and it doesn't get infected"?

[ERDoc]

Honestly, it doesn't matter what you do to it. If it is going to need stitches, we are going to irrigate it. Controlling the bleeding is the most important thing.

[Matthew99]

Fair enough. Thanks

[dera]

Just because it isn't freely bleeding right now, doesn't mean it won't later.

Bandage it well to control bleeding. Check CSM distally afterward to verify it isn't too tight, and ship 'em to the ER for closure.

[Matthew99]

"Just because it isn't freely bleeding right now, doesn't mean it won't later."

Good point!

[Bernhard]

Just because it isn't freely bleeding right now, doesn't mean it won't later.

Bandage it well to control bleeding.

Well, if it starts bleeding "later", then control bleeding at this point. I don't bandage every single cut.

But it depends highly on circumstances. Assume a small but deep cut, not bleeding. I may not even transport this to a hospital (if no other reason exists) but send the patient to a doctor on their own transport medium. For this I even would bandage it. But when the patient has an indication for ambulance transport, then likely because of other more severe injuries, then I won't loose time on the non-bleeding cut.

Again, there may be exceptions: if the wound is likely to be contaminated during transport (contact with dirt or equipment) or may contaminate staff/equipment, then I most probably would put a pad on it.

Usually I even wouldn't do a complete bandaging, a pad and some stripes of tape mostly are enough for the needed purpose in short transportation times (<20 minutes here).

Do you really really cover each single wound? My time/benefit calculation doesn't see much sense in this.

[dera]

Well, if it starts bleeding "later", then control bleeding at this point. I don't bandage every single cut.

And if they aren't with you any longer? Say, on their way to the ER via POV? If it is a deep enough lac to need further attention, it gets bandaged.

But it depends highly on circumstances. Assume a small but deep cut, not bleeding. I may not even transport this to a hospital (if no other reason exists) but send the patient to a doctor on their own transport medium. For this I even would bandage it. But when the patient has an indication for ambulance transport, then likely because of other more severe injuries, then I won't loose time on the non-bleeding cut.

Most of the time, my patients do go via POV for lacs. But you are correct, if they require more interventions, then the lowest priority wound/injury isn't tended to instantly. Doesn't mean it can't be later during transport, though.

Again, there may be exceptions: if the wound is likely to be contaminated during transport (contact with dirt or equipment) or may contaminate staff/equipment, then I most probably would put a pad on it.

Now, getting into the microbiological aspects... ALL WOUNDS ARE CONTAMINATED. Whether by whatever flora is on their skin, to the material that caused their injury, to the ground, the air, other surfaces. This is why they irrigate the hell out of wounds in the ER; to cut down on the foreign material in the wound, including those lovely microbes. I say protect it from further contamination, if possible. Do I do this for every abrasion, and small lac? Not all the time. But if I have the time, I certainly will attempt to.

Do you really really cover each single wound? My time/benefit calculation doesn't see much sense in this.

Why not? Your patient may be more comfortable for it also. Getting it covered can reduce pain from the air blowing on it. And my previous arguments of microbiological control, along with the possibility of it bleeding later. Why not prevent a little? Just because we are the ones who deal with things as they become issues doesn't mean we shouldn't work to prevent and issue from happening, or becoming worse, IMHO.

[ERDoc]

Now, getting into the microbiological aspects... ALL WOUNDS ARE CONTAMINATED. Whether by whatever flora is on their skin, to the material that caused their injury, to the ground, the air, other surfaces. This is why they irrigate the hell out of wounds in the ER; to cut down on the foreign material in the wound, including those lovely microbes. I say protect it from further contamination, if possible. Do I do this for every abrasion, and small lac? Not all the time. But if I have the time, I certainly will attempt to.

Actually, most irrigation is overrated. I didn't say it wasn't necessary but way overrated. As is sterile technique to repair simple wounds.

http://www.ncbi.nlm.nih.gov/pubmed/17456554

http://www.ncbi.nlm.nih.gov/pubmed/12216046

http://www.ncbi.nlm.nih.gov/pubmed/14985664