head laceration

[garfieldrn]

Hi everyone, I am a newbie school nurse that is seeking advice. First of I like to say: You guys are amazing! I did not realize how much you guys do until I became a school nurse myself.

Anyways, I had a kindergartener who was running outside and hit a pole. When he was brought into the nursing office he was bleeding profusely on his forehead, but after couple of minutes with direct pressure the bleeding stopped. My first wad of gauze was soaked and I threw that out and put fresh gauze to apply pressure. ( I did that so that I can see if his bleeding is stopping or not. ) When I did that the principle gave me a weird look and said "You're NOT suppose to remove the original gauze!" Once the bleeding stopped I applied steri-strip to keep the gape together. I did not wash it first cause I did not want it to bleed again and the parents were taking him straight to urgent care. The principle made a comment about not washing the wound. Did I completely screw up?? what do you guys do for a head laceration?

And I did do my neuro check....alert/oriented, pupil PERRLA.

[ChristineN, BSN, RN]

I probably would have washed it out but if his parents were taking him in right away it probably didn't make that much of a difference.

Also, your principal needs to butt out of your professional role. If the gauze is soaked of course you will change it out.

[Carpediem1012, BSN, RN]

Has the principle gone through nursing school?

[Anna Flaxis, BSN, RN]

You did fine.

[Spidey's mom, ADN, BSN, RN]

Oh dear . . . your principal must be kissing-cousins with MY principal.

One of the hazards of this job is people who have NO medical background telling you what to do.

You did fine. Just smile and go on your way.

[NutmeggeRN, BSN]

My favorite mantra "in my professional judgment......" and right after that my next fav is "not my circus, not my monkees!!"

[OldDude]

It's just a cut on the head....you're not worried about the kid bleeding to death!!

[NurseGirl525, ASN, RN]

As a parent who just dealt with my child's head laceration last weekend, yes you change the gauze. And if possible try to close it. As far as cleaning it, was the child going to the ER? My biggest concern was infection. A picture frame fell off the wall while my child was playing at practice. The corner of the frame took a tiny chunk out of his head. Just a tiny one, but it was wide and deep and did require just one staple. For such a small wound, it bled a ton. It was in his hair so unless I shaved his head, I couldn't get the wound to close. I was worried about infection primarily. But they cleaned it real well at the ER and they did that after his head was numb so he didn't feel it. I did initially put peroxide in it and some antibiotic ointment but I couldn't get the bleeding completely stopped. I went through about 3 or 4 gauze pads. I think you did exactly the right thing and the principal needs to mind their own business as they don't do your job as you don't do his/hers. I would sit down and have a conversation about that. They need to let you do your job.

[chare]

FYI: from the Injury Emergencies section of the 2010 American Heart Association and American Red Cross Guidelines for First Aid:

Manual pressure on gauze or other cloth placed over the bleeding source. If bleeding continues, do not remove the gauze; add more gauze on top and apply more pressure.

[Spidey's mom, ADN, BSN, RN]

FYI: from the Injury Emergencies section of the 2010 American Heart Association and American Red Cross Guidelines for First Aid:

Well, that's true - for a true emergency bleeding issue. But I think we can cut some slack here with a minor head lac that isn't going to kill anyone.

[ChristineN, BSN, RN]

Well, that's true - for a true emergency bleeding issue. But I think we can cut some slack here with a minor head lac that isn't going to kill anyone.

I was about to say that advice might be good if we are talking about an arterial bleed. I work in the ER and one of the things that I do in triage is when someone comes in with a laceration I apply a new clean gauze dressing until the patient sees a doctor.

[OldDude]

I can see how garfieldrn's principal, lacking experience in bleeding injury assessment, thought a cut on the head was an "Injury Emergency" as indicated in that First Aid Manual and that's why her principal thought the gauze should not be removed.