Puncture Wound

Almost any sharp object can potentially cause a puncture wound.

Common causes of puncture wounds are wood splinters, pins, nails, and glass. Puncture wounds may also be caused by objects such as scissors and knives.

It is usually fairly obvious if a person is cut. However, small pieces of glass may cause puncture wounds that a person may not notice at first. Symptoms of a puncture wound may include:

• Pain and mild bleeding at the site of the puncture
• If the wound gets infected or is not treated properly:
  • Redness
  • Swelling
  • Pus, or watery discharge

When to call a doctor

Seek medical care if:

• Wound will not stop bleeding after 5 minutes of direct pressure or is spurting blood
• Wound was caused by a nail, pen, or pencil
• You know or suspect that part of the obhect remains in the wound (urgent care may be required to remove the object)
• You are not sure when you had your last tetanus shot

You will need a tetanus shot if it has been more than 10 years since your last shot or if your last tetanus shot was more than 5 years ago, and the wound has been contaminated with dirt. This is done since immunity to tetanus may wane over time

When to go to the hospital

Seek emergency medical attention in any of the following situations:

• Wound is in the head, chest, or abdomen
• Loss of feeling, numbness, or inability to move an arm or leg below the wound
• Wound is more than 24 hours old and you develop signs of infection, such as:
  • Redness at the area of the wound
  • Swelling
  • Pus drainage
  • Fever over 100 F (37.3 C)
  • Red streaks coming away from the wound
• Wound does not stop bleeding after pressure is applied for 5 minutes
• Wound has part of an object remaining in it, such as a pencil tip, nail, or piece of glass
• Dirt remains in the wound
• Wound is gaping or there is white tissue (fatty tissue) or muscle visible
• You have a chronic medical condition such as diabetes or you take steroids
• Wound is close to or in an eye

Evaluation is based on a thorough history of what caused the puncture wound and the circumstances surrounding the event. The doctor will ask about the time from injury to evaluation, type of object that caused the injury, an estimate of the depth of penetration, inspection of the object if available, and whether or not footwear was worn if the injury is to the foot.

• Patients will be asked about the date of their last tetanus shot.
• X-rays may be taken as needed, to look for the possibility of an object left behind in the puncture wound or to assess any damage to the underlying bone.
• Ultrasound may also be performed.

• First, check to see that nothing is left in the wound.
• Check to see if the object that caused the wound is intact. If a piece is missing, it may be stuck in the wound.
• Allow the wound to bleed freely, but if bleeding is heavy or squirting out, apply pressure until it stops.
• If the bleeding won't stop, emergency care is needed.
• The basics of wound care are as follows:
  • Stop the bleeding: Minor puncture wounds and cuts usually stop bleeding without any treatment. If not, apply gentle pressure with a clean cloth or bandage. If the blood spurts or continues after several minutes of pressure, emergency care is necessary.
  • Clean the wound: The person that cleans the wound needs first to wash their hands; ideally, the person should wear sterile gloves. People may spread bacteria into the wound if their hands are not clean. Cleanse the wound; wash with water. People can use a mild soap such as Ivory if the wound is very dirty. If dirt or debris remains in the wound, clean a pair of tweezers with alcohol, and remove the dirt. If a person cannot get the dirt or debris out, the patient's doctor should be notified or they should go to urgent care or emergency center.
  • Protect the wound: An antibiotic ointment such as Neosporin or Polysporin can be used. Apply a thin layer over the wound. This will help coat and protect the wound. Large amounts of ointment are not helpful because they can attract bacteria. Apply the ointment with a clean swab or gauze. Do not apply directly from the tube in order to avoid contamination of the tube. Ointments can be applied up to 3 times a day, but individuals should always clean the wound before applying ointment.

Treatment for a puncture wound is as follows:

• The wound will be thoroughly cleansed.
• The doctor may use instruments to look for objects in the wound.
• The patient may be given a tetanus shot.
• Antibiotics may be given to people with diabetes, peripheral vascular disease, contaminated wounds, or deep wounds to the foot. Most healthy people without signs of infection, however, do not require antibiotics.

The patient will be given instructions for general wound care and specifically for puncture wounds. If the patient has other concerns or thinks they see signs of infection (such as redness, warmth, pus draining from the wound) or develop a fever, they should call a doctor.

The following suggestions can help reduce the risk of puncture wounds:

• Use sharp objects only for their intended purpose and handle with care. Keep out of reach of children.
• Do not run with sharp objects or glass in your hands.
• Always sweep up broken glass promptly and carefully avoid picking up pieces with bare hands.
• Remove nails from boards and dispose of them properly.
• Keep play and work areas free of trash and glass bottles or objects.

Most puncture wounds heal well on their own. Patients will be given thorough instructions emphasizing wound care and cleansing and monitoring for infection.

Overall prognosis from most puncture wounds (except puncture wounds from guns, long knives or deep wounds that puncture the intestines, lungs, brain or other organs, which are not the subjects of this article) is good.