View Full Version : Cut my head open...
How do I know if I need stitches?
Its sunday, I'm in the back yard cutting a rather large branch off of an oak tree, I make my three cuts, then get off the ladder to let it fall, but its not moving, so I reach in and grab the end of the branch, and pull, it snaps, but I cant get out of the way fast enough, wammo, right on the right side of my head, knocked me down, I knew I was clobbered good, so I reached up and my hand was bloody, I felt around real good, nothing broken, just bloody, .. I've got an ice pack on my head right now, should I go get stitches or do I need them or?
Shit happens. guess its not too bad, my brother the 91W said he'd check it out later, he's shopping...
Couple of basic questions...
Do you have any blurred or double vision?
Do you feel dizzy or nauseous in any way?
Do you have any pain any where else...ie, neck, shoulder, back?
Do you have any tingling in your arms or legs?
Do you have any slurred speech? Can you say the following...."You can't teach an old dog new tricks." without sounding like a drunk?
Can you see what your pupils look like, by looking in a mirror? Does one look bigger, or smaller than the other?
If you can answer yes to any of the above, you might want to get checked out.
If not, it may just sound like, as you said, "clobbered yourself pretty good."
There are a lot of blood vessels in the head/scalp area, so even a small lacerations will bleed profusely. So that may be way you're seeing "lots" of blood.
But even still, if you're not quit sure, and your brother is going to be late......go get it checked out. Your brain bucket is nothing to take lightly.
swatsurgeon
01-28-2007, 18:15
A few things......can wash with baby shampoo and water in the shower, or ivory soap.
Feel for foreign bodies...need to be removed if present.
If laceration present, is it fully through the skin layer and you can see yellow fat at the bottom or the hair follicles? If so, 3 choices:
1) get sutured...do not let them cut your hair, just use surgilube to flatten the hair away from the lac and suture with blue monofilament (proline suture...blue is easier to see and remove),
2) if your hair is long enough, take some on each side of the laceration and tie it in a knot, first apply antibiotic ointment,
3) ignore it, let it get infected and give the local surgeon some business.......
ss
So, my bro finished shopping, came over with his aid bag, and said; "you need stitches." He cleaned me up, put on a pressure dressing and took me to the urgent care, 13 staples later I'm back at the house. .... Always wear a helmet when cutting big assed branches.
Kyobanim
01-28-2007, 21:02
13 staples later I'm back at the house
Staples? Are they afraid you're brains are going to leak out?
On a more serious note . . .
What is the factor that determines if you will get staples or stitches?
.... Always wear a helmet when cutting big assed branches.glad to hear you were cutting branches...i was afraid someone had erred and sent a cherry E7 the field grade do-it-yourself lobotomy kit...:D
CoLawman
01-28-2007, 22:36
Glad to hear you got stitched up and examined. Amigo, head injuries are nothing to ignore. I have many tales about bumps on the head that were ignored and resulted in death. Again glad you are fine!
Eagle5US
01-28-2007, 22:37
Staples? Are they afraid you're brains are going to leak out?
On a more serious note . . .
What is the factor that determines if you will get staples or stitches?
On a scalp wound staples are quick, easy, and effective. Unless you are a "bald head" model, the frankenscar is pretty irrelevant because of the mop that traditionally covers it. I tend to avoid staples in blacks due to the close hair styles that are popular in that population and their scar is more in the open.
Other very large wounds (C-section) can also be optionally closed with staples. If there is a significant scar concern, plastics guys get involved with scar revision processes and procedures.
In general, the "better" you want to scar to look, the smaller suture material you use (strength of the suture for the site of injury is also a factor here) and the more time it is going to take to close it.
There are also various techniques to minimize scarring. The best cosmetic result is always considered-but areas like the face are generally given more initial consideration.
example:
I sewed a guys eyelid back together the other day and used 7-0 suture-about the diameter (and strength) of a human hair.
General face stuff usually 6-0, (maybe 2lb test fishing line)
Cuts on arms and such, 4-0 suture, like 6lb test fishing line
Large gaping wounds of legs and scalp that can be primarily closed (after closing the inner layers with absorbable suture)-skin closure by staples or heavier suture (10-12lb test).
SS Feel free to jump in here and monkey stomp my approach if needed:D
PA
CoLawman
01-28-2007, 23:07
On a scalp wound staples are quick, easy, and effective. Unless you are a "bald head" model, the frankenscar is pretty irrelevant because of the mop that traditionally covers it. I tend to avoid staples in blacks due to the close hair styles that are popular in that population and their scar is more in the open.
Other very large wounds (C-section) can also be optionally closed with staples. If there is a significant scar concern, plastics guys get involved with scar revision processes and procedures.
In general, the "better" you want to scar to look, the smaller suture material you use (strength of the suture for the site of injury is also a factor here) and the more time it is going to take to close it.
There are also various techniques to minimize scarring. The best cosmetic result is always considered-but areas like the face are generally given more initial consideration.
example:
I sewed a guys eyelid back together the other day and used 7-0 suture-about the diameter (and strength) of a human hair.
General face stuff usually 6-0, (maybe 2lb test fishing line)
Cuts on arms and such, 4-0 suture, like 6lb test fishing line
Large gaping wounds of legs and scalp that can be primarily closed (after closing the inner layers with absorbable suture)-skin closure by staples or heavier suture (10-12lb test).
SS Feel free to jump in here and monkey stomp my approach if needed:D
PA
You just shattered one of my long held beliefs . I have to admit :o I assumed the stapler came out for the indigent and sutures for the payers.
but but.. my stapler.... :D
Now, the question: Absorbable vs Nonabsorbable; where to use and when?
Eagle5US
01-29-2007, 03:52
but but.. my stapler.... :D
Now, the question: Absorbable vs Nonabsorbable; where to use and when?
I've never used absorbable staples...
Eagle
I've never used absorbable staples...
Eagle
:rolleyes:
I meant stitches... Never even heard of absorbable staples, don't know how that'd work.. lol
incommin
01-29-2007, 06:25
On a scalp wound staples are quick, easy, and effective. Unless you are a "bald head" model, the frankenscar is pretty irrelevant because of the mop that traditionally covers it. I tend to avoid staples in blacks due to the close hair styles that are popular in that population and their scar is more in the open.
Other very large wounds (C-section) can also be optionally closed with staples. If there is a significant scar concern, plastics guys get involved with scar revision processes and procedures.
In general, the "better" you want to scar to look, the smaller suture material you use (strength of the suture for the site of injury is also a factor here) and the more time it is going to take to close it.
There are also various techniques to minimize scarring. The best cosmetic result is always considered-but areas like the face are generally given more initial consideration.
example:
I sewed a guys eyelid back together the other day and used 7-0 suture-about the diameter (and strength) of a human hair.
General face stuff usually 6-0, (maybe 2lb test fishing line)
Cuts on arms and such, 4-0 suture, like 6lb test fishing line
Large gaping wounds of legs and scalp that can be primarily closed (after closing the inner layers with absorbable suture)-skin closure by staples or heavier suture (10-12lb test).
SS Feel free to jump in here and monkey stomp my approach if needed:D
PA
Are you saying that granulated tissue is not attractive??????
Think of the stories one could make up if they had a major scar running across the top of their head!
Jim
swatsurgeon
01-29-2007, 07:05
They do make absorbable staples...they suck!!!
Staples are quicker on the scalp...should have put that in my post also....I'm so used to instructing the residents on suturing technique and having them complain about wanting to use a stapler......my answer is: your grandmother can staple, a surgeon sutures......then we let them use the little machine as a reward.
It is a nice addition to a field med pack if you have the space for it.....I have used it in my tac-med world with an officer getting a wicked laceration of the forearm...washed, stapled, dressed and back in the thick of things in less than 2 minutes. Nice thing about staples it is so quick, don't absolutely need lidocaine....just staple. Feels like a nasty pinch but tolerable.....yes, we tried it on ourselves so I am speaking from first hand knowledge.
ss
Doczilla
01-29-2007, 07:07
Absorbable suture:
- To close deep layers of a wound when doing a multi-layer repair (ex: laceration to the forehead all the way to the skull). I usually use Vicryl for strength.
-Running subcuticular stitches to minimize stitch scar. Usually done with complex plastic repairs or closing surgical wounds. With the complex plastic repair, I'll revise the wound edges, close deep, do a running subcutic, and then a running 7-0 or 8-0 skin layer of absorbable sutures really close together to minimize tension on the individual sutures. Less tension = less stitch scar. Current dogma discourages subcuticular stitches in "dirty" wounds, since they may prevent draining of the wound.
- I'll use chromic gut on lips and face because there is less granulation around the suture material, leading to less stitch scar.
- If follow-up is a problem, and you don't think the patient can make it in to have their stitches removed, or if it's a child and you think they'll pitch a fit about suture removal because of where the stitches are or how they reacted to having them put in, I'll use absorbable.
Virtually everything else that is accessible: regular nonabsorbable suture, staples, "hair sutures", or superglue.
'zilla
Absorbable suture:
- To close deep layers of a wound when doing a multi-layer repair (ex: laceration to the forehead all the way to the skull). I usually use Vicryl for strength.
-Running subcuticular stitches to minimize stitch scar. Usually done with complex plastic repairs or closing surgical wounds. With the complex plastic repair, I'll revise the wound edges, close deep, do a running subcutic, and then a running 7-0 or 8-0 skin layer of absorbable sutures really close together to minimize tension on the individual sutures. Less tension = less stitch scar. Current dogma discourages subcuticular stitches in "dirty" wounds, since they may prevent draining of the wound.
- I'll use chromic gut on lips and face because there is less granulation around the suture material, leading to less stitch scar.
- If follow-up is a problem, and you don't think the patient can make it in to have their stitches removed, or if it's a child and you think they'll pitch a fit about suture removal because of where the stitches are or how they reacted to having them put in, I'll use absorbable.
Virtually everything else that is accessible: regular nonabsorbable suture, staples, "hair sutures", or superglue.
'zilla
Ok... next question to ask, what's the average time before an absorbable becomes absorbed?
My wife did a number to her finger, and after an hour and a half in the ER with no other patients IN the ER, she had only been seen by any staff once for a betadine finger bath, when she was brought in back... She was fed up, I was fed up, so we signed the AMA and left. I superglued it back together, and it's doing rather well, although when I get back from work on wed. I get to clip her fingernail off to help relieve some pressure it seems to be causing...
The ER nurse said it would need stitches, but when I got home all we had were absorbable. I didn't know if they would make the grade, as well as without pulling the remainder of her fingernail I didn't think I could go the full circumference of the laceration... so I decided the next best thing was to superglue it.
Although I cleaned it extensively prior to the superglue, it still ended up looking rather nasty...
Diagram of injury caused by a nice sharp AXE (http://www.skynet-mk2.com/photos/finger/diagram.JPG)
That was 3 weeks ago, and now she's healing up rather nicely and able to generally, although gingerly, use the finger.
I've since found out that level of care from the ER there is the norm regardless of injury type or severity, and will subsequently be taking care of things myself, or making a 30 minute dash into anchorage to Providence hospital for any severe trauma from now on.
And no, I don't let her split kindling anymore.
The Reaper
01-29-2007, 09:09
ss:
Would you care to explain the procedure and cautions (especially for females or male models) of home repairs of lacerations, especially along the vermillion borders? The surface closure is also not the only concern, there may be damage to underlying tissue as well. This could cause significant post-op problems as the vessel or nerve is left disconnected.
The fact that I would use Superglue or 100mph tape to close my own wounds does not mean that I would do that on my spouse or my kids. Especially if they are girls and you expect them to marry well some day. I am given to understand that the Frankenstein scars do not help with that process, regardless of the great story that goes along with them.
I might also point out, as an uneducated layman that to minimize scarring, the sutures need to be put in as quickly as possible, after a period of time (six hours, I seem to recall) the wound edges have retracted and granulation is going to be the primary closure mechanism.
For the uninitiated and new people here, swatsurgeon (along with selected others, like Doc T and RockyFarr) is a real trauma doc, he does not play one on weekends, on TV, nor did he stay in a Holiday Inn Express last night. I would take his advice and write it in my book when he gives it. (Eagle5US is a PA, and is in a similar category).
Thanks for the info.
TR
swatsurgeon
01-29-2007, 11:36
Thanks TR...very good points you bring up.
Lips and eyelids are very delicate areas and when repaired MUST be re-aligned just right, with the correct amount of tension across them, the correct number of layers closed and with the correct material....when all of the stars align, a nice repair occurs. If any of the factors including absolute debridement and cleaning of tissue isn't perfect, the end result is usually less than satisfactory.
As for the 6 hr rule, hit it right. After 6-8 hours we re-excise the laceration and fix it primarily. If not we let it heal 'on its own' which doesn't necessarily give the best looking scar....and YES, ALL LACERATIONS/INCISIONS LEAVE A SCAR.
Field cleaning and closure buy you time to reduce the incidence of infection and maintain function. Once back at an ED, aid station, hospital, etc, the knowledge of appropriate wound management...NOT really wound care, is paramount. Our training in wound mangement is , in my opinion, more important than just wound care. I have seen alot of wounds mismanaged that require alot more wound care and future management because of the poor care given at the first point of contact.
Never rub anything into a wound as your mother's recipe or grandma's home recipe for improved wounds. No powders, creams, salves, lotions...good old soap and water, NO hydrogen peroxide, some antibiotic ointment is fine and dress/cover it to prevent further contamination. 100mph tape, superglue all work very well as the definitive closure IF the wound is clean, doesn't need debriding and the wound gods are smiling on you.
ss
The Reaper
01-29-2007, 12:15
Doc:
As a final point, and to expound on your "wound management" statement, I would mention that MRSA, CA MRSA, and PVL are becoming more and more serious concerns.
I would be very concerned about any wound, especially one home treated, that did not appear to be healing properly or going infected and would seek professional treatment immediately.
Any danger signs that are particularly significant?
Don't forget your tetanus shot while you are at it.
TR
Two questions.
1. Tetanus shot. I just had a medical SRP last month where they go over your shot records and give you whatever shot you are short of. When I went to have this head stitched up yesterday they asked me when my last tetanus shot was, since I routinely get shots, I can't recall what each and every shot is and when I got what, but I went with the assumption that last having deployed in 05, that I got one then so I told the Dr. I was good, should I have gotten another tetanus shot yesterday? I can always go and get one this morning.
2. Hydrogen Peroxide. Why don't you use that to clean out a wound anymore?
Head, neck, shoulder sore today; no dizziness, blurred vis, headache, naseau, etc.
swatsurgeon
01-29-2007, 12:46
Wound infection is a real concern....hence, clean all wounds. Any increased redness, tenderness, drainage, seek medical attention for likely wound infection. Most times a retained foreign body is the culprit.
Peroxide KILLS fibroblasts, the cells that make you heal...as does straight betadine.
Field injuries are especially 'dirty' and if occur around a farm or pond, MUST use a penicillin type med either pill or IV...this is another area that IED/vests with bolts, rivets, nails, BBs, etc get coated in feces or pond scum and cause delayed death by infection. We carry PCN like meds and some for PCN allergic patients for these types of injuries in the locations mentioned.
***When in doubt, leave the wound open.........just cover, use antibiotic ointment, we can always re-excise and close later, safely.
ss
Kyobanim
01-29-2007, 13:22
Everytime I think we're done a new question pops up.
Peroxide KILLS fibroblasts, the cells that make you heal...as does straight betadine.
Now that I've been using peroxide my entire life I find out I've been wrong. What should you use for the cleaning of generic type cuts and scrapes?
swatsurgeon
01-29-2007, 13:31
ivory soap, baby shampoo, hibiclens......
Eagle5US
01-29-2007, 14:16
ivory soap, baby shampoo, hibiclens......
I tell people this and, no kidding, I get:
But none of that stuff is prescription:rolleyes:
Eagle
x SF med
01-29-2007, 14:50
And after cleaning it out with Ivory soap, Witch Hazel makes a great astringent and antispetic. Sorry, no prescription needed here either.
Now that I've been using peroxide my entire life I find out I've been wrong. What should you use for the cleaning of generic type cuts and scrapes?
ivory soap, baby shampoo, hibiclens......
Huh, no kidding. Learn something new everyday here.
x SF med
01-29-2007, 16:17
Hey Shooter -
Forgot to ask - how much damage did your head do to the poor branch? :D
He, he he...
Once I collected myself, I promptly started the chain saw back up and reduced the branch to 18" sections, vanquishing my opponent at my feet. I've sentenced it to rot in the sun for 12 months, and then I will burn it as my family gathers round to watch.
Seriously, that was one heavy muther... full of water. What happend is that after I made my cuts, I got down anticipating it to snap free... but it just stared at me. So, I walked around to the end of it, and grabbed hold, I gave it one tug, nothing. The second tug, "snap" it came at me and I started to jump back. There are ornamental grasses about 18" high around my feet, the grasses concealed a sprinkler, as I stepped off to get out of the way I tripped on the sprinkler, I was donefor, I ducked my head down and tried to get my arms up as I fell, but the branch struck a glancing blow from the top of my head down to my ear, and then walloping my right shoulder pretty good. This was a very, very large branch, more like a second trunk of the oak, more like a vertical growth than a lateral one. If I had let it go, well it might have split the tree some day, or so I thought. I wouldn't be talking to you if it had landed square on me. Its a good looking tree now.
My little girl, she is three, was watching all of this from the safety of the dining room. When I put her to bed last night she began her AAR by asking me why I pulled on the branches, and then proceeded to admonish me.
I have no other plans to trim anymore of my oaks any time soon.
The Reaper
01-29-2007, 17:24
I'd leave the logging up to professionals.
I am sure that for the appropriate amount of liquid refreshment, Mr,. Harsey could be tempted to come out of retirement and safely cut your oaks for you.
TR
Bill Harsey
01-30-2007, 23:12
I'd leave the logging up to professionals.
I am sure that for the appropriate amount of liquid refreshment, Mr,. Harsey could be tempted to come out of retirement and safely cut your oaks for you.
TR
NG M4,
Sounds like you have all the help here you need and I'm listening too.
Hope the healing part goes well.
Personally I've found it easier to trim heavy limbs when the whole tree is on the ground.
Thanks Mr. Harsey,
I'm doing fine. Keep waking up about an hour earlier than normal cause my staples hurt a bit. Oh, and they itch something fierce too. Anyhow, I wanted to keep the tree, so I didn't take it down; it's to the south of my house and blocks out that hot afternoon sun in the summer. Just had that one large annoying branch that grew up, and out, and then hung low over my lawn, blocking out sunlight and air, making a large area in my perfect lawn moss infested and feeble looking. When a man sits on his back patio, and admires his lawn, all accept for one ugly spot that cries out to him, well, how can you enjoy your beer while that one nasty spot is rebelling against the good order of the entire yard. It had to go. But it went at a steep price.
Kyobanim
01-31-2007, 07:31
When a man sits on his back patio, and admires his lawn, all accept for one ugly spot that cries out to him, well, how can you enjoy your beer while that one nasty spot is rebelling against the good order of the entire yard. It had to go.
That terrorist tree has to go! :D
x SF med
01-31-2007, 08:34
Shooter-
C4, electric priming, with a manual backup - no worries about the terror tree at that point - although it might annoy the neighbors. "Sorry Joe, just practicing vehicular ambushes in the backyard, y'know a little abatis action, didn't mean to wake you up from your nap..... need any frirewood? I've got everything from stovelengths to kindling, it is a little spread out. I learned my lesson last time, damn tree knocked me in the head, taught that sumbitch a lesson this time!":D
Bill Harsey
01-31-2007, 08:45
That terrorist tree has to go! :D
Kyo,
I agree but here is the funny thing and trust me I'm not trying to explain hot sun to you but Redding gets hotter than it's geographical position on the map can explain.
Must be from the harmonic convergence energy reflected off of Mt. Shasta. (Jack Moroney knows about this stuff)
That tree should serve shade duty for the remainder of it's natural life as a form of punishment for it's attempted homicide.
If that doesn't work go with our resident new age kinder and gentler arborist x SF Med's teachings as presented here.
The Reaper
01-31-2007, 09:08
Thanks Mr. Harsey,
I'm doing fine. Keep waking up about an hour earlier than normal cause my staples hurt a bit. Oh, and they itch something fierce too. Anyhow, I wanted to keep the tree, so I didn't take it down; it's to the south of my house and blocks out that hot afternoon sun in the summer. Just had that one large annoying branch that grew up, and out, and then hung low over my lawn, blocking out sunlight and air, making a large area in my perfect lawn moss infested and feeble looking. When a man sits on his back patio, and admires his lawn, all accept for one ugly spot that cries out to him, well, how can you enjoy your beer while that one nasty spot is rebelling against the good order of the entire yard. It had to go. But it went at a steep price.
You do realize that another option is to cut them off with a set of pruning shears before they reach any significant size?
Just a thought.:D
TR
SS, Doczilla, Eagle, and TR,
Thank you for the lessons/advice on wound management and care. It has already made me want to re-read my copy of Emergency War Surgery for these sections. Once I've done this and combed the net for new info I am certain I will not even see another laceration for a year or so. That's just how my luck runs, I guess. :D :lifter
Mr. Harsey,
I am glad there is one person on this board who can understand the geographical anomoly that is my city. Summer temps here, and the lack of humidity make this a good place to acclimate yourself to Iraq. You can understand my appreciation for a good shade tree. Think of Needles California, only the other end of the state. It gets Chernobyl hot here.
TR,
The wife and I bought this house last year. The previous owners let the landscaping get out of hand; I figure they stopped going in the back yard somewhere about 1996. Pruning shears are no stranger to me, but that branch was several years past the point of mere pruning. So far I've filled a 20 cubic yard dumpster with tree limbs and overgrowth, (all by myself) and I routinely make trips to the landfill. Its starting to look like a yard. Somtime about April, it will be ripe for enjoyment. I know, I know, shoulda bought a house that didn't need all the work, but the wife HAD to have this neighborhood. And they say marriage makes you live longer...
RE: Explosive tree removal. Several gov't entities might *frown* on me possessing explosives; I do try and avoid keeping explosives and their accessories 'round the house. While I am certain the local police would see the humor in removing a tree in this manner, I have no doubt they would take me to the slammer immediately. This is California I'm sure its against at least 50 or so laws. 'Sides, I am not that experienced with these things and I am fond of my fingers, and the freedom to take showers when I want to.
[RE: Explosive tree removal. Several gov't entities might *frown* on me possessing explosives; I do try and avoid keeping explosives and their accessories 'round the house. While I am certain the local police would see the humor in removing a tree in this manner, I have no doubt they would take me to the slammer immediately. This is California I'm sure its against at least 50 or so laws. 'Sides, I am not that experienced with these things and I am fond of my fingers, and the freedom to take showers when I want to.
Another option is a D9 or D10. But they can be pretty hard on the flower bed.