Puncture Wound

Symptoms

DEFINITION

• Skin is punctured by a narrow sharp object (e.g., a nail, pencil, toothpick)

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General Information

• Needlesticks: Any needlestick from a used or discarded needle should be reported immediately to the doctor. In some cases, medicines should be started to prevent transmission of the HIV (AIDS) virus.
• Foot Punctures through Athletic Shoes: Puncture wounds into the bottom of the foot have a risk of infection of approximately 4%. This increases to 25% in patients with puncture wounds through athletic (tennis) shoes into the bottom of the foot near the toes. Pain persisting greater than 4-5 days after the injury is suggestive of infection.
• Pencil Lead Punctures: Pencil lead is actually graphite (harmless), not poisonous lead. Even colored leads are nontoxic. However, they will cause a tattoo and should be scrubbed out.

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See More Appropriate Topic (instead of this one) If

• Animal caused it, see ANIMAL BITE
• It looks infected, see WOUND INFECTION
• Skin is cut or scraped (not punctured), see SKIN INJURY

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FIRST AID Advice for Bleeding: Apply direct pressure to the entire wound with a clean cloth.

FIRST AID Advice for Shock: Lie down with feet elevated.

Should I Call?

WHEN TO CALL YOUR DOCTOR

Call 911 Now (you may need an ambulance) If

• Puncture on the head, neck, chest, back, or abdomen that may go deep

Call Your Doctor Now (night or day) If

• You think you have a serious injury
• Severe pain
• Puncture on the head, neck, chest, abdomen that isn't deep
• Puncture overlying a joint
• Tip of the object is broken off and missing
• Feels like something is still in the wound
• Can't stand (bear weight or walk) on punctured foot
• Needle stick from used injection needle, and you were possibly exposed to another person's blood
• Sharp object was very dirty (e.g., a barnyard)
• Setting was dirty and puncture occurred on bare foot
• No previous tetanus shots
• Dirt (debris) that can be seen in the wound is not gone after 15 minutes of scrubbing
• Wound looks infected (redness, red streaks, swollen, tenderness)
• Fever occurs

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

• You think you need to be seen
• Diabetic and puncture wound of foot
• Last tetanus booster was over 5 years ago

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns
• Puncture through shoe (e.g., tennis shoe) and into bottom of foot
• Pain has not improved after 3 days

Self Care at Home If

• Minor puncture wound and you don't think you need to be seen

Care at Home

HOME CARE ADVICE FOR MINOR PUNCTURE WOUND

1. Cleansing: Wash the wound with soap and warm water for 15 minutes. For any dirt or debris, scrub the wound back and forth with a washcloth to remove it.
2. Trimming: Cut off any flaps of loose skin that seal the wound and interfere with drainage or removing debris. Use a fine scissors, after cleaning them with rubbing alcohol.
3. Antibiotic Ointment: Apply an antibiotic ointment and a Band-Aid to reduce the risk of infection. Re-soak the area and re-apply an antibiotic ointment every 12 hours for 2 days.
4. Pain Medication:
   • For pain relief, take acetaminophen or ibuprofen.
   • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
   • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
   • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
   • CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
   • CAUTION: Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take.
5. Expected Course: Puncture wounds seal over in 1 to 2 hours. Pain should resolve within 2 days.
6. Call Your Doctor If:
   • Dirt in the wound persists after 15 minutes of scrubbing
   • It begins to look infected (redness, red streaks, tenderness, pus, fever)
   • Pain becomes severe
   • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Photo Example

X-Ray - BB in Left Upper Arm

This X-Ray shows BB in the left upper arm.

Puncture Wound - BB Gun

This photo shows a puncture wound from a BB gun in left upper arm. Note the small hole in the arm where the BB struck and entered the skin.

First Aid - Removing a Fishhook

This is method of fishhook removal is sometimes referred to as the Advance and Cut Method.

There are four steps in removing a fishhook using this this method:

1. Step 1. Using pliers (or needle drivers) firmly grasp the hook.
2. Step 2. Push (advance) the hook until the tip of the hook pops out through the skin.
3. Step 3. Cut off the tip of the hook (and the barb).
4. Step 4. Pull (back out) the hook out.

Important Note:

• These instructions assume that you can not get into see a doctor right away. In most circumstances it is best to have a physician (or other licensed health care provider) remove an embedded fishhook.
• The hook in this drawing has only a single barb at the tip, and thus the tip of the hook (with the barb) can be cut off and the hook pulled backwards through the skin.
• Some hooks can have more than one barb along the shaft of the hook. In such cases, it is better to cut off the ring at the bottom of the hook and push the hook all of the way through the skin.

Puncture Wound - With a Foreign Body

There is a small metal splinter (foreign body) embedded in the palm of the hand.

This patient went to the emergency department and had the splinter removed.