Scalp lacerations, or cuts to the scalp, often produce a dramatic amount of blood that can be alarming to witness. This profuse bleeding occurs because the scalp is highly vascular, containing a dense network of blood vessels close to the skin’s surface. Furthermore, the blood vessels in the scalp’s dense connective tissue layer are less able to contract and seal themselves when cut. Taking quick action to control the bleeding is necessary to prevent significant blood loss.
Immediate Safety and Assessment
Before approaching an injured person, ensure the safety of the environment by checking for any ongoing hazards. If possible, use personal protective equipment, such as gloves, to protect against potential bloodborne pathogens. The injured person should be encouraged to lie down or sit with their head slightly elevated, which helps stabilize them and may reduce blood flow to the wound.
A rapid assessment is needed to determine the extent of the damage and check for signs of a more severe head injury. Look for any large, embedded foreign objects, such as glass or wood, or any obvious skull deformities. If the person is confused, unresponsive, or experiencing persistent dizziness, these may signal a concussion or internal trauma requiring immediate professional medical attention. Do not attempt to clean the wound or remove any foreign objects at this initial stage.
Sequential Steps for Bleeding Control
The primary method for controlling bleeding from a scalp laceration is the application of firm, direct pressure. Find a clean material, such as sterile gauze, a clean cloth, or a towel, to place directly over the wound. The material should be applied with constant and steady pressure using the palm of the hand or fingers.
Maintaining continuous, firm pressure is the most important part of this step. The pressure should be held for a minimum of 10 to 15 minutes without lifting the dressing to check the wound. Interruption of the pressure, even briefly, can dislodge a forming clot and restart the flow of blood, effectively resetting the clotting process.
If the initial dressing becomes completely saturated with blood, do not remove it, as this would pull away the developing clot. Instead, place a new layer of clean material directly on top of the soaked dressing and continue to apply pressure. If the bleeding stops or slows significantly, a pressure bandage can be applied to hold the dressing firmly in place and maintain compression on the wound.
This bandage should be secured snugly, but not so tight that it causes pain or impedes circulation to the rest of the head or face. For scalp wounds, a bandage may need to be looped under the chin to prevent it from sliding up and off the head. Once the dressing is secured, the person should be kept still while waiting for medical help or transport to a healthcare facility. All scalp lacerations require professional evaluation for cleaning and closure.
Recognizing Signs of Severe Injury
While direct pressure is the standard for managing most scalp wounds, there are exceptions when this step must be modified or avoided. If there is a suspicion of a skull fracture, indicated by a visible dent or deformity, direct pressure should not be applied to that specific area. Instead, gentle pressure should be applied to the edges of the wound or around the injury to control bleeding.
Similarly, if an object like a piece of metal or glass is deeply embedded, direct pressure should not be placed on the object itself. Pads should be placed around the foreign object to stabilize it and control bleeding without pushing it further into the tissue. Any signs of internal head trauma require immediate emergency medical services (EMS) activation.
Signs that necessitate an urgent call to EMS include:
- Persistent confusion or worsening headache.
- Repeated episodes of vomiting.
- Clear or watery fluid leaking from the ears or nose, suggesting a skull base fracture.
- Bleeding that cannot be controlled after 15 continuous minutes of applying firm pressure.
- Slurred speech, unequal pupil size, or any loss of consciousness, even if brief.
Aftercare and Professional Treatment
After the bleeding is controlled, professional medical attention is needed for proper cleaning and closure of a scalp laceration. A healthcare provider will thoroughly clean the wound to remove any dirt, hair, or debris, which reduces the risk of infection. Closure may involve sutures, staples, or a tissue adhesive (medical glue), depending on the wound’s size and location.
The type of closure used is determined by the wound’s characteristics, such as whether the edges are clean or jagged. Following the repair, monitor the wound for signs of infection, including increased pain, swelling, warmth, redness, or pus draining from the site. Staples or sutures are typically removed in about 7 to 10 days.