Signs and symptoms
The presence of a puncture wound usually is obvious. The important aspects of the diagnosis involve determining whether the puncture has penetrated into a deeper structure (a joint, the abdominal cavity or chest cavity, the skull, or a tendon), whether it contains a foreign body (broken needle, wood or glass splinter, or shred of clothing), and whether it is infected.
Home care
Wash the skin surrounding the puncture with soap and water and apply a non-irritating, non-stinging antiseptic such as solution – not tincture – of Merthiolate antiseptic. Be sure your child has been immunized against tetanus within the last five years. Make sure that the object that made the wound is intact and has not broken off at the tip. Inspect and feel the wound to determine if a foreign body can be detected under the skin. If no foreign body is present, cover the wound with a sterile bandage and inspect it twice a day for signs of infection (redness, discharge, swelling, increasing pain, and tenderness). Soak the wound frequently in warm water to help keep it clean. If there is a foreign body in the wound, take the child to a doctor.
Precautions
• Puncture wounds in the abdomen or chest can be very serious. Take your child to a doctor.
• Punctures of a joint may cause infectious arthritis within hours. The knee joint is particularly susceptible; a puncture near a joint, especially the knee, should be seen by a doctor. Any signs of infectious arthritis (redness, swelling, increasing pain, inability to move the joint through its full range of normal motion) should be considered a medical emergency.
• Do not remove an object from a puncture wound, not even if it is a knife blade, a nail, a splinter of wood or glass, or a needle. Let your doctor remove it. You might cause further damage if you try to remove the object yourself.
• If a puncture wound remains tender for more than one or two days, it should be seen by your doctor.
Medical treatment
A puncture wound cannot be cleaned properly, even by a doctor. Your doctor will try to determine if any foreign bodies are present by feeling the wound or by X ray. If there is anything in the wound, it may need to be removed surgically; or the doctor may wait and observe the wound for awhile, perhaps instructing you how to soak it in Epsom salts solution for five to 10 minutes four times a day. Antibiotics will be prescribed if the wound is infected, and a tetanus toxoid injection will be given if the child’s immunization is not current. If a wound has penetrated a joint, the abdomen, the chest, the skull, or a tendon, your doctor will hospitalize the child and explore the wound surgically.
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