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Instant Gratification: Repairing a Skin Tear

The last post dangled a part two. I don't have the energy for it. That shift was the only shift I've ever cried after work. Work has never made me cry. I've been doing this since August 2002. I've never cried. That shift was emotionally and mentally brutal. Colleagues told me it was painful to watch. It was that bad.

Instead, I thought I'd show you the "fun" side of things. Procedures. 

In the ED we do all kinds of procedures. We remove objects from places they don't belong, we splint, we intubate, we put back together... just to name a few. The downside is that procedures take time. We live in a society that has put gold medals on throughput, how quickly you can get a patient out. Therefore, procedures can really mess up your flow. Sad, right?

Here's a recent one I did.  

As we age, our skin naturally thins. There are other reasons, like some medications, that can also contribute to this. It is not uncommon for elderly people to have thin skin and to easily get skin tears. 

Recently, an elderly lady was not using her cane and tripped and fell outside. She had a total of four skin tears on three different limbs. Adding the length together, there was about 30 cm (about 15 inches) of torn, pulled back skin. Here's one:


Skin tears cannot be sutured. All of the skin is still present, it is just kind of rolled back on itself. After cleaning and rinsing, which is very uncomfortable to the patient, the top layer has to be unrolled, ever so gently back into place. Next, it's glue to the rescue! Basically it is medical grade super glue. It works great, but has a delayed sting that feels like a hot fire poker is searing your skin. Yet, still take it over lidocaine injections!

There it is! This was particularly difficult because of the length, a secondary tear and it kept rolling back. I didn't have a third hand, so I used steri strips to hold the most troublesome parts in place. Not my best work, as there is still a little gap. Yes, all of that bruising is new. A mild pressure dressing was applied and she was told how to deal with it at home.

So there ya go! One of the simple, yet important and time consuming, procedures we do often!

Note: if you ever get in this line of work, be warry of women over the age of 80. Particularly women of color. These are the toughest, least complaining patients you will have. They will literally be dying in front of you and won't make a sound. Truth.

Oh! You can follow me on TikTok now! @dr.jennied_dnp

*pictures used with permission

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