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.

[Anna Flaxis, BSN, RN]

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

The OP stated the bleeding had stopped, so she placed a new sterile pad on the lac. This is just fine.

[akulahawkRN, ADN, RN, EMT-P]

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..."

[garfieldrn]

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 lady partsl bleeding ...and i dont put a guaze on that, lol.

[Wave Watcher]

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.

[RNlove17]

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.

[100kids, BSN, RN]

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.

[bsyrn, ASN, RN]

I think you did just fine! We stopped using steri strips here because we found the parents were not following up with medical care once we applied them. They figured if we closed the wound and stopped the bleeding, that was all that needed to be done.