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First Aid for Scrapes and Cuts - The Wordsmith's Forge
The Writing & Other Projects of Elizabeth Barrette
ysabetwordsmith
ysabetwordsmith
First Aid for Scrapes and Cuts
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.


Facts

* Germs cause infections. If you get germs in a wound and don't get them out, you are likely to get an infection. If they are clinging to foreign objects in a wound, the chance is much higher.

* Sometimes infections kill people, so preventing that is a really good idea.

* Skin is a key defense against germs. When it is broken, it is much less good at that.

* Injuries can cause scars. Usually the damage is just cosmetic, but serious scars can impair function.

* Medical experts can be helpful. However, they are not always available, amenable, affordable, respectful, or willing to help at all.

* First aid skills can be learned according to your needs and interests. This offers multiple advantages. Most minor injuries can be treated at home with a basic first aid kit. Moderate ones can be treated with intermediate first aid skills and supplies. People with disabilities can learn first aid too.


Trends

* The more surface area of skin destroyed, the higher the chance of infection or other complications. The less destroyed, the lower the chance.

* The deeper the abrasion, the higher the chance of infection and the higher the chance of scarring; the shallow, the lower the chances.

* The messier the abrasion -- regarding the amount of grit, how much the skin is shredded, and general filthiness -- the higher the chance of infection and scarring, and the worse they are likely to get. Relatively clean wounds have lower chances.

* The more negative factors a wound has, the more likely complications will develop.

* Cleaning a wound sooner is better than later. Biking sources often recommend rinsing a scrape immediately with plain water if you don't have a first aid kit, then use antiseptic and/or antibiotic treatments when you reach a first aid tent or other resources. Germs are tiny and most don't actually move very fast, so if you quickly wash off what they are clinging to, then few will remain and your immune system has a better chance of killing the stragglers.

* Infections increase the chance and amount of scarring.

* Coverage varies. Minor injuries may not need a bandage. However, if it's in a place you're likely to bump often or it will get rubbed by fabric, cover to avoid irritation. Worse injuries typically benefit from a bandage, and you definitely need one to protect messy medication such as salve. For bad abrasions, moist dressings such as hydrogels give better results by preventing scabs from forming; the bandage acts as a temporary skin.

* Some people are much more prone to scarring than others. African-type skin is most prone to this, especially a type of hypertrophic scar tissue called keloids. It can run in families, and appears in other dark-skinned populations too. People with these traits should take extra precaution to prevent scars and treat them carefully if they occur. Caregivers with this type of skin are more likely to understand it, but someone who works with many patients of this type may also be fluent.

** For someone who gets the really bad kind of keloids that spread aggressively, consider that for anything more than minor -- you'll know what your scar threshold is likely to be -- you just rinse it with plain water, then go talk to your doctor about oral antibiotics. They'll kill germs without raising your chance of a horrible lump forming. Then coddle the injury with something like breathable tattoo lotion. Various other prescription treatments are available.  If you don't know your scar threshold, a skilled dermatologist may be able to help you figure it out.  (Thanks to [personal profile] rhodielady_47 for mentioning further treatments.)

* Some people are much more prone to infections than others. This can come from a weakened immune system, poor circulation, age, or many other reasons. Caregivers who specialize in treating these conditions often have good advice about how to prevent or treat infections for such vulnerable patients.

** A friend with such an issue reports that there are now prescription supplies specially designed for such situations, in addition to new-and-improved things you can find on a drugstore shelf. Also I have seen bandages and other things made for one-handed use, an advantage for many people with disabilities -- or anyone who has just bashed a hand and would prefer not to use it right now.


Recent Claims

Lately, advice has come out contradicting a lot of previous advice about wound care. This one not only says don't scrub and don't use antiseptics, it also advises against antibiotics. To me, this sounds like a reliable way to get infections that could have been prevented by more thorough care.

Hydrogen peroxide has one advantage that nothing else does: it foams, and it quits foaming when it's done. If you're not sure you're getting a wound clean enough, seriously consider that one. But it's high up the list of things people accuse of scar production. So if you are scar-prone, probably avoid it. If you'be been using it and it works for you with no complaints, by all means continue.

[personal profile] sporky_rat  notes:  "In microbiology class, we did comparisons of various first aid products. Hydrogen peroxide doesn't disinfect as well as say, rubbing alcohol, but it is very very good for cleaning debris out of a wound before you disinfect the wound because of the bubbles. But for disinfecting, not so great. (Which in Rural Mississippi, is a good thing, because hydrogen peroxide is way more expensive than rubbing alcohol.)"  So if you have a very dirty wound, you might want to consider hydrogen peroxide to remove foreign material from it, then choose another product to deal with the germs.  

Similarly the heavier surgical scrubs often have a distinctive color that stays on the skin. These are really popular in first aid booths at bike events and the like, partly just because they're stronger, but also because you can see what you've already treated. With a coin-sized scrape it doesn't matter; on a guy who just wiped out on gravel, it totally matters. The same argument regarding tissue damage and scarring applies.


My Observations

* Know your body. You live in it, so you can see how it responds to different injuries and treatments. If you are paying attention, nobody else will know your body better than you, even if they know more about generic human bodies. Be very suspicious of experts who try to convince you that things you observe are not so or that you should do something you have observed to be ineffective or harmful in the past, and demand more explanation.

** If you are prone to infections, treat more aggressively. If you are prone to scarring, be as gentle as possible and use products that nourish skin -- that typically means several different ones because they don't work across all stages of healing. These are contraindications. A silver allergy is an absolute contraindication for hydrogels containing silver. Other issues with infection or scarring are more often relative contraindications against certain practices or products that might work fine for someone without that trait, but with worse injuries you might need something you'd rather not use because of its likely drawbacks for you. A caregiver who ignores your stated contraindications is probably mistreating you and should be replaced if at all possible.

* Different people may have widely divergent responses to the same drug or other treatment. Reasons may include genetics, diet, habits such as smoking, health conditions, variations in "inert" ingredients, and so forth. Although this is known, I have very rarely seen caregivers account for it other than asking about allergies -- and even then, they routinely ignore that information about me. You may find that it is necessary for you to learn your body's own response patterns and assert those if other people are not careful. Notably, hydrocolloid bandages come in different materials; people with a silver allergy need to get a non-silver version.

* If you are treating someone else's injury, LISTEN TO THEM. it is their body, and they probably know it it pretty well, unless their understanding is impaired in some way. If someone starts freaking out over a minor injury, sometimes it is just nerves, but other times it's because they're prone to keloids or infections or awful experiences with caregivers. Use emotional first aid to soothe an upset victim. Also don't be a dick.

* Injuries are much less scary and painful when you know how to stay calm, control pain, and use first aid.  While they are not fun, they do offer a valuable opportunity to practice your distress tolerance skills.  It is easier to learn these from minor scrapes than from bad abrasions, and easier from bad abrasions than major trauma.  Consider the skills available before deciding whether or not to use anaesthetic.  With children who are too young to regulate their emotions, anaesthetic is a good idea; but if you never talk with them about the importance of distress tolerance, they probably won't learn it.  Once someone has learned how to handle minor pain, they can try handling more if they wish, but prioritize getting the wound really clean over practice.  Ideally, a first aid kit should include antiseptic with and without anesthetic, so you have a choice.  When treating someone else, remember to ask, "Do you want this numb or not numb?" before you start.  Indications for anaesthetic: young victim, low pain threshold, high anxiety, lots of debris to remove, etc.  Contraindications: allergy to topical anaesthetics, dissociative issues or any other body awareness difficulty, suspected nerve damage, etc.

* Both medical knowledge and available products do change over time.

** I did give up mercurochrome, which was a favorite of my grandparents. It stings like a bitch, leaves a bright pink mark, is said to increase scarring, and (at least on my body) doesn't work as well as more recent stuff.

** Bactine, a later development, is one of several relatively gentle wound rinses which includes antiseptic and anaesthetic ingredients. You may wish to explore these and see which if any works well on your body (or those you treat).

* Science is awesome.  If you know scientific method, you can test first aid products yourself.  (Warning: advice to start with a hypothesis before conducting an experiment increases the chance of bias; "what the Thinker thinks, the Prover will prove." Experiments of the "let's see what happens if..." variety may prove more helpful in early stages of exploration.)  You can test first aid products by culturing some germs, such as by making a handprint in agar or swabbing objects.  Then try to kill them. Another approach places bandage materials on agar.  Results will be more enlightening under a basic microscope if you have one, but even without it, you can see that colonies have died or quit spreading.  If you really want to scare the shit out of yourself, watch what happens to this megaplate.  Remember that you are seeing LAB conditions here, not FIELD conditions. These products may behave differently on your body!  To test that, treat your everyday injuries with different first aid products and observe any differences in comfort, infection rate, healing speed, and scar tissue.  If you are treating other people -- even within your own household -- get their informed consent first.  Mad science sucks, even the kitchen-sink version.

Always prioritize your lived experience over other people's advice, unless you know your judgement is unreliable. 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 than if ignored or just casually rinsed.


Further Observations

* If you are especially sensitive to pain, use an anaesthetic spray and wait for it to numb the scrape before further cleaning. This lowers the tendency to quit before removing all the debris.  The chance of scarring may be a little higher for some people, but a really clean wound is much  less prone to infection (which also increases scarring). (from [personal profile] mashfanficchick)

* zianuray

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Comments
From: rhodielady_47 Date: July 1st, 2017 09:37 am (UTC) (Link)
"Some people are much more prone to scarring than others. African-type skin is most prone to this, especially a type of hypertrophic scar tissue called keloids."

I remember reading years ago, that doctors often treat cuts and scrapes on people with keloid-forming problems with Cortisone injections. Don't know if this is still the preferred treatment or not, but thought I'd mention it to you.

Thanks for posting this advice. This is stuff people need to know.

AND DOUBLE THANK YOU FOR REMINDING ME THAT I NEED TO CHASE MY HUBBY OFF TO THE DOCTOR FOR A TETANUS BOOSTER!
I had one last fall when I got several booster shots at once. Heaven and the Devil alone know when the last time he had one!
:^)





Edited at 2017-07-01 09:42 am (UTC)
ysabetwordsmith From: ysabetwordsmith Date: July 2nd, 2017 08:40 am (UTC) (Link)

Well...

>>I remember reading years ago, that doctors often treat cuts and scrapes on people with keloid-forming problems with Cortisone injections. Don't know if this is still the preferred treatment or not, but thought I'd mention it to you.<<

I've heard of steroids, and when I looked it up, found a reference for corticosteroids and other stuff, so I listed that.

>>Thanks for posting this advice. This is stuff people need to know.<<

Glad I could help.

>>AND DOUBLE THANK YOU FOR REMINDING ME THAT I NEED TO CHASE MY HUBBY OFF TO THE DOCTOR FOR A TETANUS BOOSTER! <<

It's something I used to support more than I do now, but included for completion. The premise is good. But the last time I saw someone do that, it resulted in a month-long cascade of different bills and other hassle. That goes on the giant pile of burdensome reasons to avoid dealing with the medical industry. And this is for a product that should be simple, cheap, readily accessible, and useful. *headdesk*

But if you found the remindful helpful, that's good.
terrycloth From: terrycloth Date: July 1st, 2017 04:06 pm (UTC) (Link)
I'd be careful about using antibiotics routinely. Overuse of antibiotics is what gives us antibiotic-resistant infections, which are much much much more likely to kill people.

I don't think antiseptics have the same problem?
ysabetwordsmith From: ysabetwordsmith Date: July 2nd, 2017 03:54 am (UTC) (Link)

Well...

>>I'd be careful about using antibiotics routinely. Overuse of antibiotics is what gives us antibiotic-resistant infections, which are much much much more likely to kill people.<<

That's why I suggested a gradient based on need, rather than a flat do/don't. Overusing antibiotics is bad. But they're useless in the bottle. Infections suck, and they are mostly preventable.

Unfortunately the real reasons behind superbugs are not subject to individual control.

Factory farms are the worst culprit. We should do away with these, but powerful people control them, so that's not happening. It will damn well stop when the antibiotics all give out because the livestock would die and so would the workers.

Hospitals are another, because they corral sick people and breed germs that learn to travel according to hospital protocols. Not much to be done about that, as cleanroom strategies are too expensive to use routinely. (At least now. When everyone returns to dying of minor wounds, that may change.)

The one thing that's really subject to individual control, and is a big deal -- although nowhere near as big as the others -- is prescription antibiotic use. If you get a prescription, never quit because you feel better, only quit if it's intolerable. Be aware there may not be another antibiotic that will help. However, I recently learned that there's a trend toward shorter spans with higher dosage: hammer the bugs so hard they don't have time to adapt. I suspect this may be rougher on the body in some ways, although I didn't have a problem with it -- and definitely appreciated the shorter time because 5 days was a lot better than 2 weeks of my body environment off-balance.

You cannot fix the antibiotic-loss problem by nagging individuals, because they're not the primary cause. To fix it, you have to stop the factory farms. Good luck with that.

>> I don't think antiseptics have the same problem? <<

Yes, those too, although it doesn't seem to be as bad. This is because antiseptics often kill cells in mechanical ways, which is why they can kill healthy cells as well as germs. There's only so much a cell can do to circumvent chemistry and physics. Antibiotics are often more targeted -- they have to be if they're going in a body.

But again, antiseptic is no use in the bottle. If you're not going to use it when you have a messy wound, you're liable to get an infection. That's not a good thing. These are tools. Use them wisely.
zianuray From: zianuray Date: July 2nd, 2017 11:56 pm (UTC) (Link)
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"!
ysabetwordsmith From: ysabetwordsmith Date: July 3rd, 2017 02:37 am (UTC) (Link)

Thoughts

>>Having been undergoing fortnightly debridement and associated home wound care for over 2 years now <<

That sucks. >_<

>> 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.<<

I knew about lidocane, but not that it's available in that form over the counter. The only one I've seen is a sunburn product made with aloe vera gel base laced with menthol and lidocane. It can actually undo minor burns, which is amazing.

>>Also helps in cases of "picking the gravel out of road rash"! <<

I have added these observations to the post. Thank you for sharing!
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