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Scot: You cut your finger while chopping some veggies for dinner, or maybe you get a cut while you're playing sports, or a tool slips when you're working on a car or some other sort of home project. Would you know what to do? What if someone you were with got a severe cutter or a wound that just wouldn't stop bleeding? Would you know how to handle that? Recently, Mitch cut himself, and he says pretty badly. And now, he's afraid he did all the wrong things.
Mitch: Oh, I think so. I don't know.
Scot: So not only are we going to find out how badly he screwed things up, but we're also going to make sure that all of us guys know what to do in case of a severe or even a not-so-severe cut or wound.
Today, stuff guys should know, first aid for cuts and lacerations. This is "Who Cares About Men's Health," with information, inspiration, and a different interpretation of men's health. I'm Scot Singpiel. I bring the BS. The MD to my BS is Dr. Troy Madsen.
Troy: Hey, Scot. I'm ready to talk about cuts.
Scot: Good. You're the guy that's going to do that. So I'm glad.
Troy: We don't have a guest, so that's me.
Scot: Yeah. And bringing his unique perspective and also a plethora of topics to the show, because he lives them, it's Mitch Sears.
Mitch: What if I were to not have accidents and be 100% healthy? Would we still have a show?
Mitch: I don't know.
Troy: No, we wouldn't.
Scot: Troy, a question before we get into what Mitch did, and his story, and find out how many things he did wrong and how many things he did right, and what we should have done. In the ER, what are some of the more common causes of cuts or wounds that you see?
Troy: Certainly, one of the most common things I see is people cutting vegetables or cutting food and a knife slips and cuts their hand. So that's not at all uncommon. I will say the most gnarly hand injuries I see are table saws. And those are nasty. And when someone loses a finger, I pretty much know it's a table saw. It's rare it's something else, but often table saws.
We do see really, really nasty wounds, lacerations from car accidents, things like that where you're talking high-impact injuries and deep penetrating wounds. Certainly, we see people with knife wounds, stab wounds, that kind of thing as well.
But in terms of just stuff that's going to happen to you on a regular basis, we're probably talking about cutting vegetables or cutting something and slicing things for dinner, and the knife slips and gets your hand. That's the most common thing.
Mitch: Was it last year that everyone was getting avocado hand, where they were . . .
Troy: Yeah. Exactly. And there was actually an article published on it, a case series of people who had avocado hand from cutting avocados and the knife slips and cuts their hand. So, yeah, that's a new . . . I don't know that it's a new injury, but something we're seeing more of.
Scot: And that's because they're holding the avocado in their hand and they're just . . . I guess I'm trying to figure out what's going on. Because this is what I do, and probably I shouldn't be. I hold the avocado, I take the knife, and then I just circular go around the pit in the middle of the avocado, and then split it open.
Troy: Yep. And then it slips and gets your hand.
Mitch: And are you holding it when you're cutting it?
Mitch: Yeah, I'm the same way.
Troy: Yeah. See, I don't do that.
Scot: But my knife isn't super sharp. It's not the sharp knife in the kitchen.
Troy: Well, that's one of the myths though. You probably think because it's a dull knife that it's not going to cut your hand. A dull knife is worse than a sharp knife because it's going to slip more easily, and it's still going to cut your hand. Believe it or not, I cut my hand open with a butter knife. And that's ridiculous.
Scot: That's the devil right there.
Troy: If there's enough force behind it . . . Because I was trying to split apart some hamburger patties. I was having people over and I was going to grill them up. They were frozen, and it slipped and just jammed me in the hand and cut my hand open. So any knife can cut your hand. But yeah, sharper is better.
Scot: And also, the rule is never cut towards you when you're cutting something, I've heard.
Troy: Sure. Yeah.
Scot: If you're cutting tape on a box, or you're just cutting anything, especially if you have to put force behind it and you're pulling it towards you, that could be bad news.
Troy: Oh, absolutely. Yes.
Scot: All right. So the most common thing, knives. What about if people are out in the wilderness or recreating? Do you see cuts, recreational sports, those sorts of things, or is it really truly the knife is the biggest enemy here?
Troy: Well, yeah, there are pocketknives if you're out in the wilderness. Occasionally, very rarely you might see someone who gets impaled by a branch or something.
And I can say from personal experience, that happened to me while I was skiing once. A branch cut me right in the neck. And it was one of those things where I just hold my hand up on my throat and I'm like, "That did not get my carotid artery, did it? I'm not spewing blood out?" But you can occasionally see things like that.
Chainsaw injuries. I have seen chainsaw injuries as well, where people are cutting and as you take that motion down across a log, maybe it slips or goes too far and gets their leg. So I have seen very rarely but occasionally bad injuries from chainsaws.
In terms of other wilderness stuff, I will say . . . And I think my brother-in-law is okay with me telling this because he's told the story many times, and my wife has told the story many times. But we took him skiing and his skis crossed and that sharp edge on the ski, that metal edge, got him in the shin and sliced his shin open. So brought him home, sewed him up, got him back on the mountain. He was still oozing some blood out of it, so when he wrecked . . .
Scot: Right. Because the lift passes aren't cheap.
Troy: Exactly. You're going to pay and you're going to use it. So after that when he would wreck . . . Because then he had blood on his snow pants too. So when he would wrecked, you would just see blood going down on the snow. So you've got to figure all these skiers who are seeing blood on the snow were like, "Whoa, this is crazy." Anyway, those are some of the wilderness injuries I've seen.
Scot: All right. So I think we need to differentiate. There are probably different types of cuts or wounds. Is there a classification that you as a doctor use, like a minor cut versus something that's more serious? Do they have names or anything?
Troy: Not necessarily. We probably think more in terms of the location of the cut and the depth of the cut. So, certainly, cuts in the neck are very concerning. There's so much there you can injure that's very serious.
Abdominal penetrating injuries, we really worry about something that hits the bowel, the spleen, the liver. And there, it's more about the depth.
Beyond that, certainly, I think about tendon injuries and ligament injuries. So if it gets your hand, is everything moving okay? The face, we're worried a lot about cosmetic outcomes and some of the issues there if it's a laceration where it's a jagged sort of thing or it's removed tissue.
I should mention, as well, just the reality is we do see lacerations also from animal bites. That's probably a common one I should mention also, from a dog.
Scot: Oh, a dog?
Troy: Yeah, dog and cat bites. We definitely see those things as well. And those can be ones where you really have to worry about infection, in addition to just the tough things with cosmetic outcomes given that sometimes some of the tissue just is gnarly and chewed up or torn away.
So, yeah, I can't say there's necessarily just a classification system, but that's the way I think about it. I think about location, depth, and infection, and what's beneath there that's been injured, potentially.
Scot: All right. So, as we go through this, we're going to try to help give some information and learn ourselves, Mitch and I, what to do if somebody we know or ourselves, we get some sort of a cut and maybe when to make that decision that this is beyond our skill set.
Mitch, I'm curious. So you cut yourself. That's a common thing. You cut yourself. You're kind of clumsy. Is that what you've told us before?
Mitch: Yeah. I'm pretty clumsy. The person who lived with me before had the most intense first aid kit. It's a gigantic fish tackle box.
Scot: Because of you?
Mitch: Because of me. Yeah, it's pretty well stocked, and he left it before he moved out. So I'm really glad that he did. But yeah, it's embarrassing.
Troy: No, that's a great thing.
Scot: So I was just even thinking if this happened to me, if I got a cut, I would have some things I would do. But I don't even know where I've learned them. I don't know where I got this information. Mitch, when you cut yourself, how did you learn how to treat it? Was it Boy Scouts, or your parents, or action movies?
Troy: How did you cut yourself first?
Mitch: Oh, washing dishes.
Troy: So a dish broke or . . .
Mitch: Yeah. Well, we'll talk about it in just a second, I guess.
Scot: I'm laughing, and that's not cool, but I was just picturing . . . After I said action movies, I'm picturing Arnold Schwarzenegger in an action movie doing dishes.
Troy: Yeah. You need a better story, definitely.
Mitch: I know. But we're going to keep it real this time.
Scot: Yeah, let's go through. Let's find out what you did, and then Troy can comment on was it right or was it wrong? And then we can go outside of your experience, like had it been worse, what should you have done, etc. So just walk us through it.
Mitch: Sure. So I'm washing dishes, and I have a large red wine glass in one hand, and I have a sponge in my right hand. And I had put it down into the bowl of the red wine glass and was going back and forth trying to get the edge. And somewhere in that motion somewhere where I'd held it . . . It's a cheap Ikea glass, whatever. It split at a 45-degree angle, and a big chunk fell out, and as I was coming back and around that, the backside of my right thumb, it went over and in.
It was not super sharp, so it was real jagged, real bad. And so I was then bleeding all over the place. It hurt really, really bad. I tried lifting it above my head for a minute, trying to see if I could . . .
Troy: And the blood is dripping on your head.
Mitch: Yep. It's coming down. I'm looking around trying to find something to apply pressure. So I grab the dirty dish towel, which now I'm wondering, "Oh, should I have put a dirty dish towel on there?"
Scot: Well, how dirty was it really? Were you . . .
Troy: It's not like there was dirt on it.
Scot: It was drying clean dishes?
Mitch: Some food. Just little bits of food scraps or whatever. Nothing too terrible. But now, I'm holding that on. I'm lifting it above my head. I run into the bathroom. I pull it off, and it's still bleeding real bad. So I turn on the tap and I stick it underneath. It starts stinging really bad. I'm now worrying that I live in 100-year-old building. Is the tap water actually worthwhile? Is it gross? Am I just adding all of these germs into it? I don't know.
And then I'm reaching over with my other hand and pulling out the first aid kit and opening up this giant tackle box. I grab the hydrogen peroxide, and I give it a quick once-over, and it starts bubbling and everything. It hurts like a mother. And then I was like, "Oh, no. This maybe is too . . ." And it's still bleeding, so then I'm like, "Okay, here's what we'll do. I have some alcohol swabs. I'll hit it with some alcohol swabs. I'm going to make sure that this big thing doesn't get bad."
Scot: Nothing is going to live in there.
Troy: Everything is going to die.
Mitch: No. We'll go nuclear. Again, hand is still above. The blood has slowed enough that I was able to get a scooch of Neosporin in there. And then I got these big old waterproof Band-Aids, and I was able to get one on long enough that it was able to stop the leak. It bled through that Band-Aid. I changed it a few times that day. And we've been okay since.
Scot: All right.
Mitch: Yeah, interesting.
Troy: Yeah, Mitch, honestly, I don't know where to start after hearing all that. But it's a great example because I think those are all things that every one of us would think about doing in the moment. We're just like, "Well, what do I do? I'm bleeding all over the place, and I'm worried about infection. I need to sterilize this thing. And I heard about hydrogen peroxide, and I heard about lifting my hand over the level of my heart, and I heard about washing it out, but what do I . . . So I can't blame you for anything you did there.
Mitch: Yeah, you hear all of these little one-offs. And so you hodgepodge together everything you know.
Scot: You did all of them.
Troy: Exactly. So the first thing you did is you lifted it above the level of your heart. So you lifted it above your head thinking that . . .
Mitch: Yeah, shot it straight up.
Troy: . . . would help. It probably didn't help a lot, I'm guessing. It probably just made the blood drop from higher. But then you reached for the dish towel, and that's what you did right. So that's the number one thing you did. If you're bleeding, you just want to hold pressure. And if it's a dirty dish towel, who cares, honestly.
Mitch: Oh, really?
Troy: You just want to hold pressure. Yeah, it's not that big a deal. It's not like this dish towel is covered in dirt from the ground. If you're getting actual dirt in there, you get maybe a little more concerned. There, we always worry about tetanus risk. But you always want to make sure your tetanus booster is up to date anytime you have a laceration. But it's not like you're pushing dirt, or animal feces, or something crazy like that in your wound. So anything you can find just to hold pressure is the thing I'd recommend.
But then you said you ran into the bathroom and wanted to wash it out with tap water really quickly. So I'm curious, how long did you actually hold pressure on there?
Mitch: Oh, not very long.
Troy: Like a minute?
Mitch: Maybe a minute or two. I was panicking. The blood was going right through the towel. It was like, "Oh, we've got to go to the next step, next step." But maybe that was too early.
Troy: Yeah, it probably was. I will just say the step you want to just really focus on when you're bleeding is holding pressure. And it's so tempting to hold pressure for 30 seconds to a minute because it feels like it's been forever. And then you pull it off and you look, and it's like, "Wow, it's still bleeding." Hold pressure for 10 minutes. Just hold pressure on it. That's the best way to stop bleeding, is just to hold pressure on it.
Scot: Even if whatever it is, is just getting blood drenched? Just continue to hold pressure?
Troy: Yeah. Just keep holding pressure, and then just grab another one and throw it on there.
Scot: Is it as much blood as we think it is coming out in an instance like that?
Troy: Yeah, it's a good point, Scot, because often it just seems so much more. Number one, because it's our own blood. And anytime we see our own blood, it just seems like so much.
Mitch: "I'm leaking." Yeah.
Troy: Yeah, it just seems like we're bleeding profusely. And you're right, on a towel, that blood can spread out quite a ways and it looks like a whole lot more blood than we've actually put out. But the bottom line is just keep holding pressure. That is the number one thing you can do to stop the bleeding.
Scot: What's going on then? Just a couple of sentences. Don't overwhelm us with your medical knowledge. What's putting pressure on it doing?
Troy: Holding pressure, number one, allows the blood to sit there and coagulate. If the blood is just running off, it's not going to coagulate or form a clot. And it lets those clotting factors in the blood sit there and accumulate, so the bleeding will stop. So, number one, putting pressure stops the blood from coming out. Number two, it allows that clotting process to take place.
So that's the number one thing you can do. Hold pressure, sit there, just keep holding pressure. Don't feel like you need to move to the next step. Which I think, Mitch, in your mind was washing it out, which would be the next step eventually, but just keep holding pressure.
Scot: So hold pressure, and then you do need to wash it out after that? So, after the bleeding stops, then would you get the hydrogen peroxide, or the tap water, the alcohol, or the Neosporin?
Mitch: I did everything I could.
Troy: That's a great question. You did everything. The only thing on that list I would recommend is the tap water.
Mitch: Oh, really?
Troy: So a couple of reasons for that. Number one, tap water, even if it's in your old apartment that's 100 years old and you're worried what's in the pipes, I guarantee that tap water is perfectly fine to wash it out.
Studies have even been done in the emergency department looking at washing out wounds with tap water versus with sterile saline, water that has nothing in it. And these studies looked at "What's the infection risk?" There's no greater infection risk with tap water. Totally same outcomes.
So if someone comes to the ER and they've got a laceration on their hand, I just turn on the tap water in the room, lukewarm water, and I just say, "Put your hand under this for five minutes. Just let it run over it. Just let it wash it out really well." And that's what they do.
Just do the same thing at home. Just turn on the tap water, make it lukewarm, not too hot, not too cold, not uncomfortable, and just sit there with your hand under it. Or if it's a laceration somewhere else, maybe you're trying to do this in the tub, but usually, it's going to be a hand that you're doing this with. But just let it run over it.
It doesn't have to be a lot of force. You're not trying to shoot stuff through it. You're just letting it gradually run through it, wash it out. It's going to clean it out just fine.
And the thing you did there, Mitch, too, was you grabbed the hydrogen peroxide and the alcohol swabs, because obviously you're thinking to yourself, "I'm so concerned about infection. I've heard I need to use hydrogen peroxide. I need to sterilize this thing. I don't want it to get infected." I will just say here to everyone to never use hydrogen peroxide or rubbing alcohol on a wound.
Troy: Yeah. The reason you don't want to do that is because . . . Yeah, it's going to kill bacteria, but it's also going to kill healthy tissue. So all that tissue that's exposed there in the wound, it can kill that tissue off, and it just makes it harder to heal. It makes scarring worse. So just don't do it. You don't need it. Your body's going to fight off the bacteria just fine.
Mitch: Well, when I was growing up, it was always hydrogen peroxide. Always, always, always. Every scraped knee, everything, mom or dad would always get the hydrogen peroxide, roll it on.
Troy: Yeah, we've all been there. It hurt like crazy, and it just added insult to injury, and it just made us cry.
Mitch: You're right.
Troy: But it doesn't help. I know that we've all been raised that way, and intuitively you think, "I've got to get this thing as sterile and clean as possible." But the tap water is going to do the trick. Just let that tap water run over it. Your body will fight off infection. The hydrogen peroxide is just going to do more harm than good. So just don't use it. I don't recommend it at all. And like I said, it kills the healthy tissue off.
Scot: And what about the alcohol? What about alcohol in a wound like that?
Troy: Same idea. Rubbing alcohol, same idea. It's going to kill off healthy tissue. Exactly. So it's not something you need to use. I don't recommend it.
So, really, we're just looking at two essential steps here. And I know when you see something like this, you really feel like you have to do so much for it, but the two things you just need to do are hold pressure, hold it, keep it there. Don't feel like you need to move on to the next step. Just make sure the bleeding stopped. And then when the bleeding has stopped, you can just wash it out under some lukewarm water.
And it might bleed a little more as you're doing that. It's not going to usually open up and really bleed a ton. But if it's bleeding too much, then just take it out from under the water, hold pressure again for 5 to 10 minutes, and then go back to washing it out.
Scot: All right. And what about Neosporin after the fact? Does that help?
Troy: Neosporin or any other antibiotic ointments really typically are not necessary to get rid of infection or prevent that. I do tell people you can use it on a wound because . . . It's probably more just because it creates a moist environment. It helps that wound reduce the scarring. I don't know that it helps it heal up any faster. It's not something where you need to feel like, "I need to get Neosporin on this right now."
As it's healing, yeah, you could put Neosporin on it twice a day under the Band-Aid. And just creating more of a moist environment helps with wound healing. But the antibacterial/antibiotic component of Neosporin, I don't know that that makes a big difference.
Scot: All right. So two steps. Wow. Okay.
Troy: Yeah, keep it simple.
Scot: Apply pressure until it stops bleeding, and then rinse it with tap water. If it starts bleeding again, apply pressure. Just keep doing that.
At what point would you be like, "Oh, I better go to the urgent care or the ER"? Obviously, we could talk if it doesn't stop bleeding. I guess that would probably be a big one. But let's say you did get it to stop bleeding and you're looking at it, how could you tell, "Well, I better actually have somebody to still look at this"?
Troy: So that's a good point. If you don't get it to stop bleeding, you need to get some help. If you get an artery and you've got pulsatile bleeding where it's shooting out with your heartbeat, that gets more concerning.
Scot: And you can tell. The average person could tell if they got an artery. Literally, it sounds cartoonish . . .
Troy: Yeah, it's shooting out.
Scot: Yeah, it sounds cartoonish, but that's what it does?
Troy: It pumps out. Yeah, it shoots out. It's not just that thing where it's just oozing out or just keeps flowing. You can see it like a Rain Bird sprinkler. Just maybe not that far, but you can see that pulsation with the blood coming out, where it's shooting out. So that's different.
And again, hold pressure. Absolutely hold pressure there. Hold pressure and just don't let it up. But certainly, if you're talking about something like that on the larger arteries, your neck, that's a whole other situation there. If that's the situation there, that's a bad one.
But your wrist, over your radial or ulnar arteries, that can happen there if you happen to cut the palmar side, where your palm is on your hand, that side of your wrist. It would be unusual to get that in the femoral artery in your groin, but it can happen. So those are the areas that we really get concerned about an injury to the artery.
Scot: All right. So if you're just not getting it to stop bleeding, you're applying some good solid pressure for how long?
Troy: Yeah, 10, 15 minutes. It should ease up. It should not be a constant flow if you've been holding good consistent pressure for at least 10 minutes.
Scot: Okay. And if that's not happening, then urgent care or ER?
Troy: Yeah. And if it's that pulsatile bleeding, especially in those arteries I mentioned, call 911. Get an ambulance there.
Scot: Don't mess around.
Troy: Yeah. Don't mess around. If it's your wrist and it's a radial artery that's shooting blood out, hold pressure and call 911.
Scot: Now, you get the bleeding to stop. Let's say that's the situation. How big of a wound does it need to be for you to go, "I probably should get some stitches or something done"?
Mitch: That's definitely where I'm at because . . .
Troy: Okay. Oh, you're still there?
Mitch: Yeah, it's . . .
Troy: It's probably too late.
Mitch: It stopped bleeding. It's been like two days now, but it's still sizable when I take the Band-Aid off.
Scot: Was it deep enough that you felt like you got bone or anything like that?
Mitch: Not bone, no. But definitely some nerves in there. It hurts differently than just a basic sting.
Troy: Yeah. So, in terms of stitches, it's often a judgment call, but if the wound is gaping, meaning the edges of the wound are apart, and let's say a quarter of an inch apart, half inch apart, and they're just not staying together, that's probably when you need stitches. The whole point of stitches is just to hold the wound together so it heals up well.
And the reality is all wounds will eventually heal. They're all going to fill in. It just may mean it leaves a bigger scar, or it takes longer to heal, or you could have an increased risk of infection because it's sitting open for longer, where the stitches close it up and prevent that.
It is a little bit of a judgment call. But that's my rule of thumb. If it's a gaping wound, if it just is not holding together well, then you probably need stitches.
And in some areas you're going to have bigger issues with that than others, like on your forearm or something. You could probably hold it together pretty well with a Band-Aid versus something maybe a little further up your arm near your elbow where it's bending and it just keeps popping it open. That's just not going to heal up well unless you've got stitches holding it closed.
Scot: And then there's cosmetic considerations too. If it's gaping, it's not going to heal. You're going to have a bigger scar.
Troy: Yeah, you are. You're going to have a much lower threshold to come in for something on your face than on your arm or your legs. Yeah, definitely. And that's something we always think about with the face, is the cosmetic concerns. We're much more likely to sew something up.
Even in some cases where it's pretty minor, you can use just the tissue adhesive, the Super Glue for the skin, and that works really well. We use that in the ER. And you can get some stuff over the counter that's not quite the same thing, but it's pretty close, and you can even try using that stuff too.
Mitch: That was going to be my next step, and I didn't know whether or not that would be a good idea or bad idea.
Troy: Yeah, and that's tough. The reason it's tough is because the longer a wound stays open, the more you just need to leave it open to heal. Well, there's a fine line there. So, typically, if someone comes in the ER and they tell me . . . Let's say you came in and you've had this wound, and it's now been two days. And let's say I looked at it and I said, "We need to put stitches in that." I would say, "We can't do it right now because it's just been open for too long."
Now, that being said, sometimes we'll give it a few days, like three or four days, and then at that point, we'll do what's called a delayed closure. But usually, for most wounds, especially on the hands and feet, far away from the heart where there's not good blood supply, usually those you have to close them up within 12 hours, or the infection risk really goes up.
And we'll go up to 24 hours on the face, just because the face, you're nearer to the heart, you've got good blood perfusion there, you've got blood there that's going to fight infection. It's not like you have to get right in the ER or the urgent care.
But if you're talking about a hand wound, you probably want to get there within the first six hours or so.
Scot: Can they stitch in the urgent care?
Troy: Oh, yeah.
Scot: All right. Cool.
Troy: Yeah, that's great place to go. And then they can do all their other assessment, because you've got to worry about the stuff underneath there too. Like I said, if there's nerve damage, if there's tendon damage. We always worry about lacerations that go into the joint as well. If you cut deeply and it goes into the joint or gets the bone, things like that, they can get X-rays. They can do all that evaluation there.
Scot: And worth getting that looked at then. Would you say if somebody cut into a tendon or cut into a joint or something, they would know?
Troy: Usually, you're going to know. It's possible to partially cut the tendon. The joint is sometimes tougher to know. But if it's a deep laceration right over a joint . . . So let's say on your finger right where your finger bends, if it's a deep laceration and you're looking at it, you're like, "Wow, I'm concerned that's down to the bone," you probably need to get into at least an urgent care so they can wash it out really well, get a good look at it, and see if there's any injury to that joint.
And again, the reason we worry about the joint is because you can get infections in the joint itself. So if that happens, if it is in the joint, typically you're going to see an orthopedic specialist and they're going to actually really wash that joint out well before they do any kind of wound closure.
Mitch: Okay. So it's pretty closed. I think I'm okay. But if I keep an eye on it, if it's been exposed, whatever, what about signs of infection? What am I looking for and when is it that I need to go to the doctor to see what's going on?
Troy: So definitely redness around the wound. That being said, though, every wound as it heals is going to get kind of red. That's just part of the inflammation process of healing. So as that process is going on, you're always going to see a little bit of redness around a wound.
But when you really see a lot of redness and warmth where it's expanding maybe an inch or two beyond the borders of the wound. Certainly if you're seeing pus draining from the wound. That's tough too because as part of the healing process, you may see a clear drainage from there sometimes. But if you're actually seeing just this yellow/greenish stuff coming out of it, that gets concerning.
And then beyond that, sometimes as things really get worse, you'll start to see these red streaks going up your hand or going up your arm. That's much more concerning for an infection.
And something I always worry about with the hand is if you cut, say, your hand on the front part, the palmar side of your finger, if it gets down in the tendon, you can get an infection along the tendon. And usually, there you're going to have a lot of trouble bending or straightening your finger. And if you push along that tendon as it goes up your hand and then up from there, it really hurts all along there. Sometimes the finger gets really fat and swollen too. So that's definitely more concerning for infection.
But big thing is redness and drainage, fevers. If it gets really bad, you may have a fever.
Scot: All right, Mitch. How are you doing?
Mitch: I'm okay. I just feel dumb. I don't know. I cut myself washing dishes, and then it's just like, "Oh, man. Maybe I should have gone into the urgent care."
Troy: Like I told you, I sliced my hand open with a butter knife trying to split frozen hamburgers apart. And then the worst part of that is I was too embarrassed to go into work. It was more like one of those things where, "I don't want to go in." Maybe it was more that. "I just don't want to deal with this." So I just washed it out really well. I held ice on it because that numbed it up, and then I grabbed some stitches and I stitched it up myself. And that's what I did.
Scot: Sometimes you just don't want to face your co-workers.
Troy: No, you really don't. I was just like, "I don't want to deal with this. I don't want to go in."
Scot: So you still think maybe you should have gone to an urgent care or an ER then, Mitch, or . . .
Mitch: Just based on some of the things that he was saying . . . It kept bleeding for a while after. It was me more putting Band-Aids on top, trying to keep it from overflowing. And then just with how wide it has stayed over the last day or two, it's like, "Oh, I probably should have gone and gotten a stitch."
Troy: Yeah. It's tough, though. I bet if you had held pressure for longer, it would've stopped bleeding a lot faster.
Troy: That's a tough thing with Band-Aids. They're going to absorb blood, but they're not really putting a lot of pressure on there.
Scot: So, in Mitch's case, the bleeding did eventually stop. What about severe cuts? You hear that maybe you should use some sort of a tourniquet or something like that. Is that a good way to apply pressure, or not so much?
Mitch: The old Boy Scout manual makes it seem like you've got to put a tourniquet on the second it happens.
Troy: Oh, I know. It really does. And that's something I learned in Boy Scouts too, is the value of a tourniquet. I would say avoid a tourniquet at all costs. And the reason I say that is just because if you're using a tourniquet, you're going to cut off the blood supply to that wound, and you're going to cut off the blood supply to that entire limb.
So there's a chance not only are you not going to bleed out of the wound, but you're going to lose that limb potentially, if you use a tourniquet.
That being said, very rarely a medical transport team will use a tourniquet. And that's in a case of life-threatening bleeding. But I personally would not recommend using it, unless someone has . . . Let's say you have that chainsaw injury, I mentioned, and it takes off your leg or someone's leg, and it's the only way you're going to stop that bleeding.
But just avoid a tourniquet unless you think the person is absolutely going to die because they have lost a limb and they're bleeding out from it.
So, yeah, it's something I think we think about because of those Boy Scout manuals and lessons we may have learned, but just try to avoid a tourniquet. Just hold pressure. That's the number one key. Hold pressure.
Scot: Yeah. And I'm just going to take this to the extreme. So,we've got Mitch cutting himself on a wine glass, and then we've got a situation where somebody's bleeding really, really badly, and you're like, "I don't know if pressure is going to be the right answer." But pressure is always the right answer, and then trying to get somebody there that's a professional as quickly as possible. Is that true? Is pressure always the right answer when somebody's bleeding, no matter how bad?
Troy: Ninety-nine point nine percent of the time, yes. There are extremely rare cases where a tourniquet may be necessary. But just don't even think about it, unless it's just a dire situation. And just realize that if you use a tourniquet, they may well lose their arm or leg.
Scot: Okay. So the best thing you could do if you're in a situation where somebody's bleeding really badly is apply pressure.
Troy: Yep. Apply pressure and hold it.
Scot: And call 911.
Troy: And call 911. Just hold pressure there. And you can get an ACE wrap on there, too, to hold pressure on it. You can wrap that around there pretty tightly. Certainly not so tightly it's cutting off the blood supply like a tourniquet would, but anything you can do just to hold pressure.
Scot: Yep. And get that coagulation to start happening.
Troy: Yeah, exactly.
Scot: The clotting.
Troy: Get the clotting to happen. Yep.
Scot: All right. Takeaways. Mitch, do you have one?
Mitch: Okay. So it's a lot easier than I thought. It's pressure plus tap water. It doesn't require five bottles, and a panic attack, and all the . . . Yeah.
Scot: Yep. And waving your hand above your head like you're one of those flailing arm guys that you see at car dealerships.
Mitch: I know. But again, that's advice that I've gotten from other people. I was told, "Oh, be sure to raise it above your heart." And it's like, "What am I doing?"
Scot: The takeaway for me is just to time.
Mitch: Oh, sure.
Scot: I think, like Troy said, it's easy to have it on there for 45 seconds and go, "Is it done yet? Is it done yet? Is it done yet?" So 10, 15, 20 minutes isn't unheard of from what I'm gathering.
Troy: Exactly. Yep.
Scot: All right. And Troy, do you have any takeaways? I don't know how that might work out, but I'll ask.
Troy: My takeaway is the stuff Mitch did is stuff we've all done. And it's stuff that has at least crossed my mind in that moment where you're bleeding and you're just thinking, "Wow, I'm bleeding so much." It's just very different when it's happening to you and it's not someone else.
So sometimes I've had to remind myself, "Just hold pressure." Just hold pressure and don't keep looking every 30 seconds. Just keep it on there. Even look at the clock and say, "I'm going to leave it on for five minutes and I'll look after five minutes."
Scot: All right. Well, this is a good episode. It's a good episode if you ever find a situation where either you are bleeding or somebody that you're with is bleeding. How do you handle that? It's a simple two steps.
If you have ever had a situation or if there's a question you have . . . Maybe Mitch didn't do something you would've done. I don't know how that's possible, but I guess it could happen. You could reach out to us at any time via email email@example.com. That's firstname.lastname@example.org.
Thank you for listening, and thank you for caring about men's health.
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