Burns and lacerations: When to go to Urgent Care

It’s almost impossible to get through life without a few cuts and burns. Sometimes the injury is minor and you can take care of it at home. But other times, it’s important to get medical attention quickly. Cape Cod Healthcare’s Urgent Care centers can handle about 90 percent of all cuts and burns, according to emergency physician Jonathan Fletcher, MD, but the first care for cuts and burns starts at home.

“Before they come in, whether it’s a cut or a burn, the first thing I would say is rinse the area really well with some tepid tap water for at least a few minutes and then cover it with a clean dry bandage of some sort, whether it’s a clean hand towel or if they’ve got gauze in the house, cover it and then come on in to see us,” he said.

“The other thing that’s really important for people to know: Don’t wait a day to come in. Come in the same day, whether it is a burn or whether it is a laceration, because if someone has gone more than 24 hours, especially with a laceration or a burn, we are less likely to close it and to put sutures in it.”

Many burns also include lacerations and the risk of infection is high if you wait a day or two before seeking care.

Degrees of Severity

Burns are divided into four degrees of severity:

• First-degree: like a sunburn, where your skin turns red and it’s sore.
• Second-degree: when you start to get blistering.
• Third- and fourth-degree: there is blood, bone or tissue exposed.

The Urgent Cares can handle even third- and fourth-degree burns if the burn is small and isn’t in a sensitive area of the body, Dr Fletcher said. Sensitive areas include the face, palms of the hands, soles of the feet and the genital region. Emergency doctors use extra caution with injuries in the sensitive areas, for cosmetic reasons and because there are a lot of sensory tissue nerves that sometimes need a closer follow-up. They could also need a consultation with a specialist.

An example would be a small child suffering second-degree burn on their genitals in a hot bathtub. That child would probably be sent to Boston Children’s Hospital for care, he said. An adult with the same burn would be sent to Cape Cod Hospital or Falmouth Hospital for burn follow-up.

“The takeaway is that anyone can come to Urgent Care but if it is in one of those sensitive areas or if it is something that requires closer follow-up, I would want patients to understand that there is a chance that they could go to the hospital,” Dr. Fletcher said.

Treatment May Differ for Children

There are other times a child might be sent to the hospital. Treatment for burns and lacerations are different for adults and children, Dr. Fletcher said, mostly because kids might need sedation even for an exam. This is especially true for children under the age of five. If the doctor can’t get a good examination, even after trying to distract the child, they usually send them to the hospital Emergency Department where sedation is available.

When it comes to lacerations, there are things you should do at home first, he said. After cleaning the wound with tepid water, apply pressure to control the bleeding. If it is an open wound and the margins are not approximated, meaning you can see into the wound or if you have to put pressure on it to close it, you will need some kind of closure technique. It could be done with sutures, staples or Dermabond glue, depending on the severity of the wound.

Patients, regardless of age, with cuts or lacerations should also know their tetanus status. If they haven’t had a tetanus shot in 10 years, they will need to get one at the time of treatment.

“Anytime where there is exposed tendon or bone, they should really go to the Emergency Department,” Dr. Fletcher said. “We can evaluate it and see them in the Urgent Care but chances are if there is exposed tendon or bone, we’re going to be sending them over because a cut tendon or exposed bone oftentimes need a specialist follow up like hand surgery or orthopedics. Sometimes if there is bone exposed, they actually need to go to the operating room.”

Any laceration that included a neurovascular injury should go straight to the Emergency Department, as well. An example would be if you get a laceration on your arm and your hand goes numb. That indicates you have injured an important nerve and Urgent Care is not equipped to accommodate that.

If you have pulsatile bleeding where the laceration sprays every time your heart beats, that means you have injured an artery. Dr. Fletcher recommends calling 911 and going straight to the Emergency Department in that case because you could actually need vascular surgery to repair it.

Same Level of Care

No matter where you are treated, you can expect the same level of high-quality care. Dr. Fletcher spends about 30 percent of his time treating patients at Cape Cod Healthcare’s various Urgent Care centers around the Cape. The other 70 percent of the time, he works in the Emergency Department.

“One thing that sets Cape Cod Healthcare’s Urgent Cares apart from the rest of them is patients are being treated and seen usually by a board-certified emergency medicine physician. Or if it’s one of our PA’s (physician assistants), they are being supervised by a board-certified emergency medicine physician who is right there,” he said.

There are six Cape Cod Healthcare Urgent Care centers across Cape Cod. Hyannis, Harwich, Falmouth and Sandwich are open year-round and Orleans and Osterville are open for the summer season.