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Thu 23 Jun, 2005 05:12 pm
This just happened, writing here first and then going off to research more, hope to get some commonsensical answers...
We were at the pool and sozlet (age 4.5) came running towards me (on concrete.) She did a stutter-step and almost fell on her face at about 10 feet away, and a Very Stern Maternal Lecture ensued (she knew she wasn't supposed to run, and was going fast enough that it would've been very bad.) She was upset about the lecture, and cold, and I warmed her up, and it was time to go anyway (she was showing signs of hunger-induced hyperness), so we packed up and left.
Not until the parking lot did I notice that her left big toe was bleeding profusely. She was upset about the lecture but hadn't said anything hurt. She saw the blood and freaked out. Calmed her down, got her in the car, got her home. Checked it out under good light and *I* freaked out (I seem to have hidden it well enough so far, she's doing fine.)
About a quarter of her toenail has been torn off, and there is bad tissue-y globby stuff under there. Total area gone is maybe 1/4 - 3/8 of an inch square. The bleeding stopped, an initial gloop but not much more, just that it's raw.
We have no urgent care option, only option tonight is to go to ER. That is always a major undertaking, with hours of waiting and horribly sick people spreading their germs. Can try to get to regular doc first thing tomorrow.
I have put regular antibiotic cream (thinly spread on bandaid, not directly applied) and a bandaid on and that doesn't quite feel sufficient.
Seems like a major infection risk.
Thoughts?
Nothing?
I've sent out a bunch of SOS's (or at least Info Please!!'s) and responses are trickling in, I'm feeling a little better about it I think. One thing I'm not sure of is how to clean it. One recommendation was soap and water. I tend to think that since it bled and wasn't exposed to anything after that (she didn't re-enter the pool for example) water would tend to drive any little microbes in rather than clean anything more than it is.
Hydrogen peroxide, soz.
It won't hurt as much as soap or alcohol, and it will kill the germs. Then put on some more antibiotic cream and a bandage until you can see the doctor.
Breathe deeply. She'll be just fine.
I'd just use a light bandaid - and clean it and watch it.
I have done that heaps of times - it is nasty and hurty, but it seems to fix itself pretty fast.
My trusty Mayo Clinic family health book is being singularly unhelpful about this (nothing about toenails beyond athlete's foot and such, nothing about cleaning or treatment of this specific kind of wound), but it does say to use mild soap and water for "minor wounds." This is probably minor, but it also says, "if the mouth of the wound is not easily closed, seek a physician's care."
I'm mostly un-freaked, thanks for your input. I think I'm fine with waiting until tomorrow to call the doc (and probably bring her in). But I really want to do the cleaning thing right, and I'm finding a bunch of contradictory suggestions.
My mom's a nurse, wrote to her too and hope she'll be able to get back to me soon.
Yoiks!
Quote:Nails grow back slowly. It takes about 6 months for a fingernail and up to 18 months for a toenail to grow back.
Guess I better stock up on bandaids... (She's been going through them like they're going out of style as-is... summer...)
Ouch!
My daughter did that not long ago. Soap and water to clean it will do the job, then applying a topical antibiotic cream, which you did. Cover it with a padded dressing that won't stick to the nail bed. That will also protect her toe and help keep it clean. Change the dressing every day and keep her foot away from water for a couple of days.
Thanks mckenzie! That's exactly what I was hoping for, that someone would have experienced it directly or indirectly. How much did your daughter lose? Has it grown back yet?
Re: the padded dressing, would a bandaid work or should I get something else? I have various dressings in my first aid kit...
What's weird is that the hurt part has so far not been a factor -- maybe it will kick in after a while? First it was the lecture that she focused on, then the blood itself, but once it was cleaned and bandaged up she was fine.
OK, I gotta bite the bullet and clean things more throroughly I think.
I have no idea soz but I was thinking that marathon runners have lots and lots of toenail problems - you might Google for stuff about toenail care under under "marathon toenail" or something like that.
Poor sozlet.
sozobe wrote:Yoiks!
Quote:Nails grow back slowly. It takes about 6 months for a fingernail and up to 18 months for a toenail to grow back.
Guess I better stock up on bandaids... (She's been going through them like they're going out of style as-is... summer...)
Isn't that re-growth estimate for when a full nail is ripped out? My experience with ripped off nail segments is that bandages are only needed for a while - and oddly (?) I always have better recovery from cuts/open wounds/nail segment loss if I spend a fair bit of time in the swimming pool. hamburger has a theory that it's because of the chemicals in the pool.
Hmm... well what happens when it's a segment? I'd thought it was something like a thin film would appear, and then get stronger until it was nail-strong -- if it's just that it will stay the way it is (eek) until the nail grows over it, that would be less time than the full nail.
Anyway, optimistic that she'll be able to see the doc tomorrow and can find out the longer-term stuff then -- mostly trying to figure out what I should be sure to do before bed tonight.
I like the way this site covers nail bed injuries
http://www.emedicinehealth.com/articles/5449-4.asp
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mmmmm, I usually lose a bit more nail before it starts growing back. Annoying, but part of the re-growth. I've got a friend who has lost a few nails to improper false fingernail removal - the doc cuts them back further first <ick>.
Keeping it clean and dry is key. Of course, keeping it dry doesn't mean it can't get wet at all i.e. dry it very very well after washing the wound.
mrs. hamburger, paediatric nurse, is an advocate of keeping wounds (after the initial couple of days) covered during the day, and uncovered/unbandaged at night. Seems to have worked well for all and sundry over the decades.
soz, she lost about a third of the nail on her big toe. She lost about 1/3 to 1/2 of the nail and it took months, maybe six, to grow back. Ironically, it happened on a pool deck, as well. (Her part-time job in uni. was a lifeguard/swim instructor.)
I bought Johnson & Johnson Sterile Non-Stick pads. They were too large, so we had to cut them to size, and then used waterproof tape to secure them to her toe. The pad absorbed the fluid discharge and kept it away from her toe.
Once the nail bed was dry and her toe wasn't as painful, she switched to regular bandaids.
Given the number of people in the world who go barefoot all their days and the fact that children in these cultures trip and fall and rip away their toenails with distressing regularity, there are remarkably few one-legged people.
The profuse bleeding was probably a genetic development to insure the survival of impulsive children. The original bacteria have been washed out of the wound. You just have to take defensive measures to be sure than no new creepy crawlies enter the wound.
The Sozelet may be old enough to listen happily to the glories of Tom Sawyer's sore toe. Or was it Tom Sawyer's friend's sore toe? I would forbid her to charge money for a glimpse of the wound.
Hold your dominion.
The nail bed will dry, but she won't have a nail until it grows back. It's a little unsightly but no longer painful.
ehBeth wrote:sozobe wrote:Yoiks!
Quote:Nails grow back slowly. It takes about 6 months for a fingernail and up to 18 months for a toenail to grow back.
Guess I better stock up on bandaids... (She's been going through them like they're going out of style as-is... summer...)
Isn't that re-growth estimate for when a full nail is ripped out? My experience with ripped off nail segments is that bandages are only needed for a while - and oddly (?) I always have better recovery from cuts/open wounds/nail segment loss if I spend a fair bit of time in the swimming pool. hamburger has a theory that it's because of the chemicals in the pool.
Salt water is fabulous too.
I have left mine uncovered, once there is a scabby thing, except when wearing shoes (I always go barefoot a lot, though). Once that forms, they seem to heal very fast. Good blood supply, I guess?
Ugh, your link says she should be seen within 6 hours by an emergency department, ehBeth.
Fret.
I think I'm ready to wait until tomorrow.
mckenzie, thanks so much for your input. Those dastardly pool decks! OK, I have a better concept of how this works. Just "dry", eh? Hope at least some skin grows back over it?
Noddy wrote:I would forbid her to charge money for a glimpse of the wound.
Oh, scabby thing, good. Scabby thing sounds better than just a dry open wound... ewww...
sozobe wrote:Hmm... well what happens when it's a segment? I'd thought it was something like a thin film would appear, and then get stronger until it was nail-strong -- if it's just that it will stay the way it is (eek) until the nail grows over it, that would be less time than the full nail.
Lol - they grow from the bottom up, Soz!
The nail will cover it as it grows up - it won't form a thin film of nail.
Relax - really - I did this a thousand times as a kid.
I did something similar to a toe a few years ago. After the scab healed, there was tender skin there for a while before the nail finally grew back over it.
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