Scalp lacerations often appear more alarming than other wounds because they produce a copious amount of blood. This dramatic bleeding is due to the scalp’s exceptionally high vascularity, containing a dense network of arteries and veins near the surface. These blood vessels are embedded within a thick connective tissue layer, which holds the damaged vessels open, preventing them from naturally constricting and clotting. This anatomical arrangement means even a shallow cut can result in significant blood loss, requiring immediate first-aid intervention.
Scene Safety and Initial Assessment
Before treating a scalp laceration, ensure the environment is safe for both yourself and the injured person. Always use protective barriers, such as disposable medical gloves, to minimize the risk of exposure to bloodborne pathogens. Visually assess the injury while minimizing movement of the head and neck, as a spinal injury is possible. Look for signs of a skull fracture, which changes the bleeding control approach, such as a visible depression or dent, bone fragments, or clear or yellowish fluid draining from the wound, ears, or nose. If a fracture is suspected, proceed with caution to avoid pushing bone fragments into the brain tissue.
Step-by-Step Guide to Controlling Bleeding
The most effective method for controlling bleeding from a scalp laceration without a suspected skull fracture is applying firm, direct pressure. Use sterile gauze, a clean cloth, or clothing to cover the entire wound, applying sustained and steady pressure directly over the bleeding site for a minimum of 10 to 15 minutes without interruption. Do not lift the material to check if the bleeding has stopped before the full time has elapsed, as this interrupts the clotting process. If blood soaks through the material, simply place a new layer of gauze or cloth directly on top and maintain consistent pressure. Continuous compression helps the body’s natural coagulation factors form a stable clot within the damaged vessels.
If a depressed skull fracture is suspected, direct pressure must be avoided over the fracture site. Instead, create a donut-shaped ring or pad from rolled gauze or a clean cloth to encircle the wound. Apply pressure to the intact scalp tissue around the injury. This technique controls bleeding by compressing surrounding vessels while preventing inward pressure on the potentially fractured skull. Once bleeding is controlled and a clot has formed, secure the dressing firmly with a bandage or tape, ensuring it is snug but does not constrict the head or neck.
Signs Indicating Immediate Medical Attention
Certain signs indicate the need for immediate professional medical care. If bleeding cannot be controlled after 10 to 15 minutes of sustained direct pressure, seek emergency assistance immediately, as this may signal a substantial vascular injury. Systemic symptoms can point to a serious underlying head injury, such as a concussion or traumatic brain injury. These signs include confusion, loss of consciousness, persistent or worsening severe headache, repeated vomiting, or any abnormal behavior. The leakage of clear or yellowish fluid from the wound, ears, or nose is also a medical emergency, as this fluid may be cerebrospinal fluid, indicating a fracture at the base of the skull. Wounds that are large, deep, or have widely separated edges will require professional cleaning and closure with sutures or staples.