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head laceration

Posted

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

Specializes in Pediatric/Adolescent, Med-Surg.

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.

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

Specializes in kids. Has 25 years experience.

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

OldDude

Specializes in Pediatrics Retired.

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

NurseGirl525, ASN, RN

Specializes in ICU.

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.

ChristineN, BSN, RN

Specializes in Pediatric/Adolescent, Med-Surg.

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

Specializes in Pediatrics Retired.

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. ;)

akulahawkRN, ADN, RN, EMT-P

Specializes in Emergency Department. Has 6 years experience.

From a Standard First Aid viewpoint, the Principal was correct. That's a standard response about what to do when blood soaks through... just slap on another pad and continue to hold direct pressure. Yes, you want bleeding to stop, you don't want to dislodge established clots, and so forth, but Standard First Aid doesn't teach how to deal with wound care beyond that, just that they're supposed to refer to a medical professional for further evaluation. As I see it, the nurse did exactly the right thing. Next time, just be polite but firm: "In my professional judgment..."

Thank you everyone for your input, theres just so much to learn. My background is in l&d and the only bleeding i get is vaginal bleeding ...and i dont put a guaze on that, lol.

Wave Watcher

Specializes in Community Health/School Nursing. Has 7 years experience.

If you were in L&D then you should be use to seeing (principal) and dealing with a**holes. lol

You did just fine. Makes my blood pressure rise and my eye twitch when someone tries to tell me "what I did wrong" and they have NO educational/training background in nursing/medical school. I'm not beyond admitting I'm wrong, or saying "I don't know" or learning something new but don't approach me in the manner your principal approached you. Grrrrr.

This sounds like a minor laceration. Changing the bloody gauze was appropriate. Leaving it would have been appropriate too but for a smaller/minor laceration, I'd change it. I probably would have at least rinsed the wound but since he was going to urgent care, they would clean the wound there. The principal clearly is the type who thinks he has a nursing degree. Has no idea what we learned in nursing school and probably only has a dim idea of what nurses actually do. He has no professional background, no medical or nursing license... so it was your call on what to do.

Once the bleeding stopped it was totally acceptable to discard the bloody gauze and apply new. I would have probably rinsed it out before applying the new but given that he was going right to urgent care you were fine.

Regardless the principal should have stayed out of it! If they wanted to be the School Nurse he/she should have gone to Nursing School. I get so tired of people telling me how I should do my job. How bout you do yours and I'll do mine.