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Wound care questions--frustrating evening at ER


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I was cleaning a narrow glass lighting fixture when the neck broke and sliced open a small but deep wound at the base of my second (longest) finger, extending from the top of the finger around and down towards the skin web between my fingers. I went to the ER for stitches.

 

I had a very, very frustrating experience there. I have had stitches before, as have my children, so I have a decent frame of reference for how this is supposed to work. Unfortunately the ER doc took a real dislike to me despite the fact that I was calm, sweet, rational, and trying so hard to be sweet. I turned down what I considered to be an unnecessary xray, and an unnecessary tetanus shot. (I don't object to the tetanus vaccine, but don't think the risk of tentanus with this imjury is all that high and would prefer to check my records for when I had a tetanus shot last.)

 

The icing on the cake was the fact that she did not do a good job with the stitches. I have never been in this situation before--other occasions that called for stitches looked different. I asked her about a part of the wound that looked like it was coming apart, and she was short with me. I was apologetic and syrupy sweet and ended up asking for surgical glue in addition because it was clear to me that the stitches were inadequate. (I think I needed one more, and think that one of the stitches is way too close to the edge of the skin and am concerned it will pull out. I didn't say all that to her though--I just apologetically asked about the part of the wound that was pulling apart.) When she was doing the stitching she was rough, with a lot of tugging and impatience, also totally unlike other occasions that I or my kids have had stitches. She did put the glue on.

 

I then waited forty minutes for bandaging. When the guy came in he took a big band-aid from the cupboard and mashed it over the top of my fingers, pressing part of the adhesive ON TOP OF THE EDGE OF THE WOUND. At first I started to leave, but then realized that the bandaid adhesive was ON the wound and knew that I had to get it off immediately. There was enough bacitracin (petroleum jelly-based antibiotic gel) so that I could ease off the bandaid. I saw the same guy in the hall and told him I was unhappy because the adhesive had been ON the wound and I said gauze would be more appropriate and that I wanted it re-wrapped.

 

I then had to argue with Mr. Incompetent about his wrapping of the wound. He put a large gauze pad on top of my fingers and started wrapping, which meant that the part of the wound in between my fingers did not have a pad on it. In the course of all this he told me in outraged tones not to be mad because they have a lot to do there, and asked me if I felt I should wrap it myself. I was not yelling, lecturing, or berating, though I am sure my unhappiness was written all over my face.

 

Here are my questions:

Is it okay to scrub the wound with alcohol AFTER the stitching and glue? Because a tech did so, and I am afraid she dissolved the glue. If so, I can go buy some bandaid glue and try again???

 

I was really unhappy with the wrapping. When I got home, I unrwrapped, found that most of the bacitracin at the hospital had gotten wiped off by all the adventures with Mr. Incompetent. I squirted on huge globs of bacitracin and put on a small, nonstick sterile pad over the wound and in between my fingers. (It has a cotton wadding core with a light plasticky kind of shell). I then wrapped the two fingers together, then wrapped a little more around my whole hand to keep it stable. Was this okay to do?

 

Much of my hand was numb from the shot. However, I also experience light hand numbness due to spinal compression. How can I tell if I wrapped the gauze too tight?

 

Do I really have to go to the dr in 2 days to check for infection? Can I just check myself?

 

Do I really have to get a dr to snip the stitches or can I snip in 10 days?

 

ETA: I should really get a round of applause for typing this with my left hand and right index finger. Just sayin.'

Edited by strider
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first off OUCH!

 

I had a lovely rotation slice in my middle finger years ago when I broke a glass while washing it (hand inside rotated hand to clean glass and basically "peeled" my finger.

 

Anyway, I did in fact have to go in every 2 days to have it checked and redressed. Mine finger was put in a splint to prevent the stitches from ripping, fingers are so hard to stitch (I had 7 in it). WHich is essentially what you did wrapping them and so I would say it was the right thing.

 

I had them removed on the 10th day and it was good the dr was doing it, a couple of them the skin was healing over the knots of the stitches and they were hard to get out.

 

The other thing getting them checked every 2 days is good for, is to check for ripping. If they are poorly done or tear the dr at the time can add another stitch or some glue to better serve the wound.

 

As for how to tell if too tight. Push down on your finger nail and release. If color returns quickly it is good, if not they are too tight.

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first off OUCH!

 

I had a lovely rotation slice in my middle finger years ago when I broke a glass while washing it (hand inside rotated hand to clean glass and basically "peeled" my finger.

 

Anyway, I did in fact have to go in every 2 days to have it checked and redressed. Mine finger was put in a splint to prevent the stitches from ripping, fingers are so hard to stitch (I had 7 in it). WHich is essentially what you did wrapping them and so I would say it was the right thing.

 

I had them removed on the 10th day and it was good the dr was doing it, a couple of them the skin was healing over the knots of the stitches and they were hard to get out.

 

The other thing getting them checked every 2 days is good for, is to check for ripping. If they are poorly done or tear the dr at the time can add another stitch or some glue to better serve the wound.

 

As for how to tell if too tight. Push down on your finger nail and release. If color returns quickly it is good, if not they are too tight.

 

thank you. stuck a popsicle stick in the gauze and taped it down. Typing entirely one-handed now. Am really angry that er didnot splint.

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thank you. stuck a popsicle stick in the gauze and taped it down. Typing entirely one-handed now. Am really angry that er didnot splint.

 

Either pick a splint up at the drug store tomorrow or when you go back in in 2 days request one. It really should have been splinted imo, especially with the cut being near the base of the finger, everytime that finger moves it could rip the stitches out. Are you going to your regular dr for the follow up care? I had mine initially fixed in the Er and then it was my GP that took care of the follow up. I got the stitches out after 10 days and then they had me keep the splint on for a few more to let the spots the stitches had been in heal too.

 

Now my injury knicked the tendon so I don't know if that is why they initially splinted it, but to me it makes perfect sense

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Ack! That sounds awful!

 

I'd be following up with the doctor because I'd be afraid they did something wrong.

 

That you held it together around such incompetence is impressive!

 

Standing ovation for this and the typing!

 

:hurray: :hurray: :hurray: :hurray: :hurray:

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:grouphug: :grouphug:

 

Oh My. Yes, I would go to the Dr in 2 days just so you can lodge complaints with a professional. That's my .02, but here's why.. When I was a teen I was glueing together a decorative plate Mom had that fell & broke. She was going to ditch it, but I knew she loved the plate & I was certain I could fix it. While holding it in place I used too much force & the piece slipped from my left hand & sliced the last two knuckles on my left hand deep enough that 1, I couldn't stop the bleeding, & 2 I needed stitches.

 

I worked for a Dr at that time, but I didn't call him because I felt family time was family time & work time was work time. Instead I went to the ER where they forced me to take a pregnancy test, "because if I had a dollar for every teen who says they've never had s.x & shows up pregnant..", amongst other things. The shots were extremely painful {duh}, & the dr began working before it kicked in.

 

To top it all of with he was rude & mean. He only put five stitches in all together. When the Dr I work for saw it he was outraged by the entire situation. he felt I should have AT LEAST double the stitches. He felt they were sloppily done & so on. He told me next time I had an emergency to please call him, he was that upset. He then turned to Mom & told her NOT to pay the bill. Instead he told her to lodge a complaint. Tell them she didn't feel the medical care given was appropriate & the follow up Dr agreed stating that the stitches were poorly done & should have been more, etc.

 

The hospital took her complaint very seriously & wiped out the bill. Now, we'd had ER visits before that & had a humdinger of a time with some of the people in there as well as the billing department, so even Mom was shocked that her complaint was taken THAT seriously. She expected to have to pay for at least the items used in treating my hand, but she didn't. It was wiped out entirely.

 

I'd lodge a HUGE complaint with the follow up Dr. I would go back to a pro for having the stitches removed, & I'd lodge a massive complaint against the people who saw you in the ER. Not only does it sound like you were treated very poorly, it sounds like they were totally incompetent. Putting a sticky bandage upon an open cut is just unreal! I've never been given stitches {nor my children} & had them use an adhesive bandage. Always gauze & tape. Or at least a large gauze pad over the wound {when we had the purple glue} & then the bandage on top of that so they could be certain the wound was clear of the tape. I'm just shocked by how you were treated!

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:grouphug: :grouphug:

 

Oh My. Yes, I would go to the Dr in 2 days just so you can lodge complaints with a professional. That's my .02, but here's why.. When I was a teen I was glueing together a decorative plate Mom had that fell & broke. She was going to ditch it, but I knew she loved the plate & I was certain I could fix it. While holding it in place I used too much force & the piece slipped from my left hand & sliced the last two knuckles on my left hand deep enough that 1, I couldn't stop the bleeding, & 2 I needed stitches.

 

I worked for a Dr at that time, but I didn't call him because I felt family time was family time & work time was work time. Instead I went to the ER where they forced me to take a pregnancy test, "because if I had a dollar for every teen who says they've never had s.x & shows up pregnant..", amongst other things. The shots were extremely painful {duh}, & the dr began working before it kicked in.

 

To top it all of with he was rude & mean. He only put five stitches in all together. When the Dr I work for saw it he was outraged by the entire situation. he felt I should have AT LEAST double the stitches. He felt they were sloppily done & so on. He told me next time I had an emergency to please call him, he was that upset. He then turned to Mom & told her NOT to pay the bill. Instead he told her to lodge a complaint. Tell them she didn't feel the medical care given was appropriate & the follow up Dr agreed stating that the stitches were poorly done & should have been more, etc.

 

The hospital took her complaint very seriously & wiped out the bill. Now, we'd had ER visits before that & had a humdinger of a time with some of the people in there as well as the billing department, so even Mom was shocked that her complaint was taken THAT seriously. She expected to have to pay for at least the items used in treating my hand, but she didn't. It was wiped out entirely.

 

I'd lodge a HUGE complaint with the follow up Dr. I would go back to a pro for having the stitches removed, & I'd lodge a massive complaint against the people who saw you in the ER. Not only does it sound like you were treated very poorly, it sounds like they were totally incompetent. Putting a sticky bandage upon an open cut is just unreal! I've never been given stitches {nor my children} & had them use an adhesive bandage. Always gauze & tape. Or at least a large gauze pad over the wound {when we had the purple glue} & then the bandage on top of that so they could be certain the wound was clear of the tape. I'm just shocked by how you were treated!

 

Heading to bed, but have one more question. When rewrapping the wound after I took the bandaid off, the tech did NOT rewash or sterilize. He just put on the gauze. When I rewrapped at home, there was still a light film of bacitracin on the wound. Is it okay to assume that the wound was clean enough and protected by the bacitracin? The ER dr had been quite clear to not get the wound wet, so I don't want to fuss with it again unless I have to do so.

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Ack! That sounds awful!

 

I'd be following up with the doctor because I'd be afraid they did something wrong.

 

That you held it together around such incompetence is impressive!

 

Standing ovation for this and the typing!

 

:hurray: :hurray: :hurray: :hurray: :hurray:

 

:iagree::grouphug:

Unacceptable behavior from the ER all around. Definitely complain, absolutely follow-up to make sure it is ok.

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:grouphug: That sounds like a horrible experience. :grouphug:

 

I think I might be tempted to contact a hospital administrator on Monday, and let them know how your experience went.

 

:iagree: No matter how busy they are, they shouldn't get away with being unprofessional.

 

Sorry you cut your hand. I sliced my first finger on my left hand from the palm to the first knuckle on a blender blade a couple of years ago, and they didn't even do stitches, just the glue and butterfly bandage. The glue fell off like the next day, so I just bought more butterfly bandages and splinted my finger until it healed.

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ABSOLUTELY do NOT pay that bill, and complain, complain, complain to the right people until you are satisfied with their response.

 

The way they treated you was completely unacceptable.

 

I had a similarly awful experience with Moose at a walk-in clinic when he needed his last round of stitches removed (two stitches in his chin). I've never in my life encountered a doctor as incompetent and rude as the one we met that day.

 

I ended up getting my $60 co-pay (which I had paid BEFORE meeting the doctor) reimbursed, along with an apology and an assurance that the doctor and the rest of the staff would be taking classes in how to deal with pediatric patients.

 

The ER, and those who work there, are for emergencies. Cutting your hand so that you need stitches *is* an emergency. YOU are the reason those people have a job. They had NO right to treat you the way they did.

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I was cleaning a narrow glass lighting fixture when the neck broke and sliced open a small but deep wound at the base of my second (longest) finger, extending from the top of the finger around and down toward the skin web between my fingers. I went to the ER for stitches.

 

I had a very, very frustrating experience there. I have had stitches before, as have my children, so I have a decent frame of reference for how this is supposed to work. Unfortunately the ER doc took a real dislike to me despite the fact that I was calm, sweet, rational, and trying so hard to be sweet. I turned down what I considered to be an unnecessary xray, and an unnecessary tetanus shot. (I don't object to the tetanus vaccine, but don't think the risk of tentanus with this injury is all that high and would prefer to check my records for when I had a tetanus shot last.)

 

The icing on the cake was the fact that she did not do a good job with the stitches. I have never been in this situation before--other occasions that called for stitches looked different. I asked her about a part of the wound that looked like it was coming apart, and she was short with me. I was apologetic and syrupy sweet and ended up asking for surgical glue in addition because it was clear to me that the stitches were inadequate. (I think I needed one more, and think that one of the stitches is way too close to the edge of the skin and am concerned it will pull out. I didn't say all that to her though--I just apologetically asked about the part of the wound that was pulling apart.) When she was doing the stitching she was rough, with a lot of tugging and impatience, also totally unlike other occasions that I or my kids have had stitches. She did put the glue on.

 

I then waited forty minutes for bandaging. When the guy came in he took a big band-aid from the cupboard and mashed it over the top of my fingers, pressing part of the adhesive ON TOP OF THE EDGE OF THE WOUND. At first I started to leave, but then realized that the bandaid adhesive was ON the wound and knew that I had to get it off immediately. There was enough bacitracin (petroleum jelly-based antibiotic gel) so that I could ease off the bandaid. I saw the same guy in the hall and told him I was unhappy because the adhesive had been ON the wound and I said gauze would be more appropriate and that I wanted it re-wrapped.

 

I then had to argue with Mr. Incompetent about his wrapping of the wound. He put a large gauze pad on top of my fingers and started wrapping, which meant that the part of the wound in between my fingers did not have a pad on it. In the course of all this he told me in outraged tones not to be mad because they have a lot to do there, and asked me if I felt I should wrap it myself. I was not yelling, lecturing, or berating, though I am sure my unhappiness was written all over my face.

 

Here are my questions:

Is it okay to scrub the wound with alcohol AFTER the stitching and glue? Because a tech did so, and I am afraid she dissolved the glue. If so, I can go buy some bandaid glue and try again???

 

Yes you can glue the wound yourself but before doing so you need to clean the open area again with a antibacterial solution.

 

I was really unhappy with the wrapping. When I got home, I unrwrapped, found that most of the bacitracin at the hospital had gotten wiped off by all the adventures with Mr. Incompetent. I squirted on huge globs of bacitracin and put on a small, nonstick sterile pad over the wound and in between my fingers. (It has a cotton wadding core with a light plasticky kind of shell). I then wrapped the two fingers together, then wrapped a little more around my whole hand to keep it stable. Was this okay to do?

 

Yes it was ok to redress

 

Much of my hand was numb from the shot. However, I also experience light hand numbness due to spinal compression. How can I tell if I wrapped the gauze too tight?

 

check for full circulation at end of fingers are they pink and warm and also you can check or capillary refill by squeesing the end of the finder it should blanch white and when you let go turn back to pink within a few second if its not returning pink quick then you have a circulation problem

 

Do I really have to go to the dr in 2 days to check for infection? Can I just check myself?

 

signs of infection redness, swelling, fever. The wound should be in the early stage of healing within 48-72 hours. The wound are is a light pink NOT red in anyway

 

Do I really have to get a dr to snip the stitches or can I snip in 10 days?

 

stitches are easy to remove with small scissors and tweezers, just clean wound snip along top and pull each strand. Manicure sissors work best makesure to clean both skin, scissors, tweezer in alchol before you begin.

 

ETA: I should really get a round of applause for typing this with my left hand and right index finger. Just saying.'

 

I am a ER nurse and it sounds like you got one of the traveling contract doctors. The E/R doctors don't get the same autonomy practice money that other physicians. They are at the mercy o a hospital like us nurses. The thing is there is a shortage in some cities. There are the traveling ones that can contract more money. They are not always that good and just don't get called on it. I would complain the the hospital. The 40 min wait time for bandaging may be from laziness or it may of been from a more critical situation coming before you. I don't normally recommend patients taking care of themselves cause well we get sued for breathing wrong but this is internet no mans land. I hope you heal quickly

Edited by Cafelattee
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I am a ER nurse and it sounds like you got one of the traveling contract doctors. The E/R doctors don't get the same autonomy practice money that other physicians. They are at the mercy o a hospital like us nurses. The thing is there is a shortage in some cities. There are the traveling ones that can contract more money. They are not always that good and just don't get called on it. I would complain the the hospital. The 40 min wait time for bandaging may be from laziness or it may of been from a more critical situation coming before you. I don't normally recommend patients taking care of themselves cause well we get sued for breathing wrong but this is internet no mans land. I hope you heal quickly

 

It's very kind of you to answer my questions. I have no interest in suing anyone--I just want to take care of this without going to the ER again. It's been a very, very expensive year for us medically. Thank you for your help out here in internet no-man's land.

 

I bought a splint at a med supply store this morning. I redressed simply by squirting on more bacitracin, applying a nonstick sterile pad to the wound and taping in place. I then taped on the splint. I did not sanitize. Finally, I wrapped with gauze.

 

The wound is a little sore but not bad. There was no redness or swelling or streaking. I have not washed or attempted to apply glued. The wound looked moist (from the bacitracin) and is a tight, narrow line, so perhaps no more glue?

 

At what point is the wound allowed to get wet? At what point do I sanitize with something like hydrogen peroxide?

 

Should I just continue with the bacitracin and rewrapping once tonight, twice tomorrow, and then on Monday morning? (Twice a day regimen or is that too much???) I will try to see a dr on Monday, though I am hopeful that I can just continue taking care of this and being careful.

 

Again, thank you.

Edited by strider
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My rule of thumb when it come to stitches getting wet is just don't. I am sure it is okay after a few days but I feel better to not get teh area wet until the stitches are removed, because I am weird like that. No more glue at this point since the wound is tight, leave it be. peroxide I would not do at all. Peroxide kills good tissue as well as bad so unless it was a massive infection I would not want to kill off the brand new tissue being formed. Between you keeping an eye on it, and the dr checking it every 2 days you should be able to prevent infection in it and therefore no peroxide needed.

 

I would not rewrap twice a day, that is exposing it too much imo. leave it until tomorrow unless the dressing becomes loose or dirty. Redress it once tomorrow and then Monday see the dr.

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My rule of thumb when it come to stitches getting wet is just don't. I am sure it is okay after a few days but I feel better to not get teh area wet until the stitches are removed, because I am weird like that. No more glue at this point since the wound is tight, leave it be. peroxide I would not do at all. Peroxide kills good tissue as well as bad so unless it was a massive infection I would not want to kill off the brand new tissue being formed. Between you keeping an eye on it, and the dr checking it every 2 days you should be able to prevent infection in it and therefore no peroxide needed.

 

I would not rewrap twice a day, that is exposing it too much imo. leave it until tomorrow unless the dressing becomes loose or dirty. Redress it once tomorrow and then Monday see the dr.

 

Thanks again for the help.

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