Ow!

February 28, 2010 11:57 AM

Last night, I fell down and split my chin open. It looks deep enough to need stitches. Caveat: I don't have health insurance. Should I go to the ER?

I was coming home from work and slipped on the stairs. I hit my chin on the fall and now have a pretty deep split. It was late, etc., so I cleaned, stuck a towel under it, and fell asleep.

12 hours have elapsed from the fall. It's still bleeding but not as much. It looks really bad, enough so that I'm getting worried. It's probably one to two inches long and the split is deep enough so that I can see the yellow fatty tissue.

However, I do not have health insurance. Yes, I am a full-time employee. Yes, I've tried to seek state insurance to no avail.

Is it worth it to go to the ER? How much will it cost approximately?

posted by fiasco to Health & Fitness (44 answers total)

How concerned are you with scarring?
posted by box at 12:00 PM on February 28, 2010

Do you have any free clinics in your area? I also currently have no health insurance and recently had to go to the free clinic for a bad flu bug. You might have to wait a while but they should be willing to help. Places like this usually have a scale based on your income so yes, it might cost but if you truly are in need they won't deny you based on you being able to pay or not.
posted by deacon_blues at 12:01 PM on February 28, 2010

The biggest issue is scarring, as box said. It'll (probably) heal as it is, but you'll have a rather nasty mark if you don't get stitches (and soon(.
posted by SNWidget at 12:02 PM on February 28, 2010

Best answer: An urgent/immediate care center can handle this, if there's one open in your area. It would be much cheaper and faster than the ER. IANAD, but It could be too late to stitch now, though - they'd probably have to look and see.
posted by dilettante at 12:02 PM on February 28, 2010 [3 favorites]

Response by poster: I'm pretty worried about scarring. . I mean its on my face. Also, it's been twelve hours and the wound won't stop bleeding... I'd post a photo but I don't want to gross anyone out.

Thanks for the advice.. I'm trying to check for free clinics in MN, but my google searching is failing me.
posted by fiasco at 12:05 PM on February 28, 2010

You could super-glue it if you had to. It'll still probably scar, but not as bad.

It'll sting like a motherfucker, though.
posted by InsanePenguin at 12:07 PM on February 28, 2010

Best answer: Everyone here is going to tell you to seek medical attention immediately. While that's prudent advice, I've been in your situation recently, and I know what it's like to treat yourself to avoid costly medical bills. If you decide to treat this yourself...

1) Keep the wound clean. Once this gets infected it's game over, and you'll need a doctor, which will cost more later than just going to a doctor now.
2) Keep the wound clean. Wash your hands thoroughly before removing the dressing. Keep your bathroom clean. Don't remove it to show people the scar, etc. I'm a big fan of Neosporin-type ointments to keep the cut supple and clean.
3) Use a butterfly bandage to keep the wound closed and allow it to start healing. You can also buy butterfly bandages at the store.

There's going to be lots of "IANYD" etc, but hey, you know that, and that's why you're asking the internet about medical advice, and not going to a doctor. If you can possibly afford it, do it, and if not, avoid infection and the wound will mostly take care of itself.

Hope you're ok with a scar. A doc might be able to stitch you up cleanly. The DIY method will probably leave a decent scar.

I don't know what this will cost. My daughter popped her elbow out of socket recently, and while we were waiting to see a doctor it popped itself back in, and that cost us $280. For nothing. Well, they did weigh her. Good luck. Hope you can get some insurance soon so next time you won't have to worry about this.
posted by spikeleemajortomdickandharryconnickjrmints at 12:08 PM on February 28, 2010 [2 favorites]

I am not recommending this, since I am not a doctor. But, if you decide not to go to a doctor, at the very least go to a drug store and buy butterfly strips or 'steri-strips.' You'll still scar, and it doesn't help with infection, but they will effectively hold it closed and let it start healing.

Again, I am not saying this is the way to go, just if you do decide to pass on medical care.
posted by scrute at 12:08 PM on February 28, 2010

It might be too late to get stitches at this point. I once tried to get a finger stitched about 8 hours after I cut it open and they told me it was too late. I had to make due with super glue.
posted by lilac girl at 12:09 PM on February 28, 2010

I see spikeleemajortomdickandharryconnickjrmints beat me to it!
posted by scrute at 12:10 PM on February 28, 2010

In the event that you have no choice but to go to the ER, make sure you speak with someone in the billing department as soon as possible so you can get on a payment schedule. You also might be able to negotiate a "cash rate" which could knock some money off the bill.

This might help? Not knowing the city you're in, it's harder to narrow it down. The link is for urgent care centers, not free clinics. Oh, here's a list of free clinics in MN. Don't know how good the list is, YMMV, etc.

(and here's another link for free clinics)
posted by cooker girl at 12:11 PM on February 28, 2010

I split my thumb open a few months ago, and I was able to get the bleeding to stop. I was pretty determined not to go into the ER, although my wife found it prudent to call the nurse hotline anyway. Apparently, the main criteria for needing medical attention on a cut is if it's a wound that won't stay closed on its own. The nurse pretty well convinced me to get my butt in there, even though I thought I would be okay. I'm glad I went. Although I am not a medical professional, based on my conversation with the nurse, I'm suspect they would be pretty insistent on getting it checked out.

I'm not sure how much it costs without insurance. If you have a free clinic option, that would be a great way to go. My feeling, though, is even if it does cost something, you won't regret it, for health reasons, or for the scar issue. Most hospitals provide payment plans.
posted by SpacemanStix at 12:15 PM on February 28, 2010

You know how much my last trip to an urgent care center cost me?

$67, with blood tests. No insurance.

I have no idea how much your medical problem with cost you, probably more, but some of the advice in this thread is idiotic.

If you can find an urgent care center attached to a major hospital, that would be the way to go. Talking to a plastic surgeon is something you will be thankful for when you're done with school.
posted by 517 at 12:16 PM on February 28, 2010

By the way, when I got my thumb worked on, they used the steri-strips and surgical glue. There's no scar. It has a lot to do with the angle and location of the cut, though, to determine if it's viable over stiches.
posted by SpacemanStix at 12:17 PM on February 28, 2010

Best answer: In my personal experience, they declined to secure a wound of similar depth and breadth on my thigh with stitches beyond the 12 hour mark, as these apparently harbor a substantially increased risk of infection. The wound was disinfected, steri-strips were applied, and I was advised to come in immediately if there were any increase in redness, or if I noticed copious amounts of discharge/weeping. I strongly suggest visiting an Urgent Care ASAP (especially so if you are prone to keloid scarring.) I can't imgine the trip would set you back more than $2-300; though, if it does, you may be able to seek local or state aid/relief.
posted by biggity at 12:18 PM on February 28, 2010

If you really must see a doctor, I'll second the recommendation that an urgent care clinic is going to be cheaper for most non life-threatening problems, especially without insurance.
posted by KirkJobSluder at 12:20 PM on February 28, 2010

If you're concerned about scarring, I would go to urgent care or the ER. You can set up a payment plan, and people get WAY more expensive things than stitches done to them without insurance and manage to make it work.
posted by ishotjr at 12:28 PM on February 28, 2010

Go to the hospital, tell them you do not have a social security number. People who migrate to this country illegally get their surgical care billed to MediCaid, why shouldn't you?
posted by meadowlark lime at 12:32 PM on February 28, 2010

Ow. You poor thing. I did this once, and called a doctor right away (sorry, I can't help with the financial part, I come from a place where we have public health care) and he stitched it up right away. The others are right that it might be too late to stitch - the face heals very fast, too - but I think you should definitely consult a doctor just to make sure that the wound is clean and so on.

I don't know where in Minnesota you are, but start your Googling here; if you can't find one in your city, perhaps try calling a major clinic (eg this one in Minneapolis and ask them if they can point you in the right direction>?
posted by different at 12:41 PM on February 28, 2010

Go to the hospital, tell them you do not have a social security number. Bad advice. People who migrate to this country illegally get their surgical care billed to MediCaid, (untrue) why shouldn't you? Lying about one's social security number doesn't somehow magically let the provider bill Medicaid.

Urgent Care is the place to go. Cheaper than the hospital ER, and if it's too late for suturing at the Urgent Care, it's too late at the ER too. Free clinics (assuming you could qualify) are typically not open on Sunday.
posted by Snerd at 12:47 PM on February 28, 2010

Lying about a social security number and attempting to get Medicaid if you are doing so fraudulently is also a way to get arrested. Good medical care in jail, but lousy sleeping accommodations. Go to the ER and tell them up front that you don't have insurance and you can't pay immediately. The worst they can do is turn you away. This is no worse than your present situation. The best they can do is treat you and work something out for you to pay a reduced bill over time. Nothing ventured, nothing gained, but don't try fraud. It's so messy.
posted by Old Geezer at 12:59 PM on February 28, 2010

It might be too late to get stitches at this point. I once tried to get a finger stitched about 8 hours after I cut it open and they told me it was too late.

Exactly the same thing happened to me (mine was on my palm). Not because of infection but because the edema that sets in over the first few hours means stitching it would cause more damage rather than less. It was pretty obvious for me, the whole palm of my hand had gone hard, although the doctor said they can never stitch something more than a few hours old. So you're most likely too late for that anyways.

Infection is a big problem though, even a low level subclinical infection will slow healing and increase the change of scarring, and if the wound's that deep it probably needs professional cleaning. I actually had a stone stuck way deep in mine which I never would have noticed otherwise, totally worth having them take a look. I also had my hand bound closed with special breathable tape which I then left on for a couple of weeks (they checked it every few days), it did a far superior job than butterfly tape or superglue or whatever. Probably every bit as good at stitches in the end, the whole area was immobilised and held together correctly (mine was a very ragged cut going right back to the bone and it healed OK). So while I agree that the ER probably isn't necessary, a trip to any kind of urgent care or whatever today would be a good idea. They can do a much better job of taking care of the wound than you even if they can't stitch it.
posted by shelleycat at 1:05 PM on February 28, 2010

If you go the DIY route with the butterfly bandages, which the ER may well have used, then the issues are 1) clean and 2) align.

Have someone look very closely in your wound, for any pieces of debris, gravel chips, sweater wool, etc, and get that out. Obviously you will use the usual methods recommended by the pharmacist, to clean a minor wound.

If it's a clean cut, align it as exactly as possible. If torn and scraped, be very careful once you have realigned the gash, and try to put each of the dangling bits and serrations back where they came from.

Carefully lay the butterfly down on the closed wound, and do not use it to pull the wound closed, if possible. Use several bandages. Use any extra ones around the same area to limit the ability of the skin in that area to stretch normally during motion.

Keep it dry, covered with sterile fabric, let it breathe a little. Watch closely for any indication of infection, which might appear first as itching, as well as redness.

I'm not a doctor, just a guy who's had a lot of wounds closed, both by professionals and DIY.
posted by StickyCarpet at 1:19 PM on February 28, 2010

I'd get it looked at, one of the problems is that it is your chin and the skin is constantly moving around, making it harder for a cut to close itself over.
posted by jacalata at 1:20 PM on February 28, 2010

That's a good point, jacalata. They do have some kind of elastic neck band for people trying to fight the effects of aging. If you could find one that didn't cover the injury, it might not be a bad idea, at least around the house and while sleeping.
posted by StickyCarpet at 1:29 PM on February 28, 2010

nthing urgent care. I opened my palm, watched the fat drifting out, knew I needed help. I chose my doctor over the ER on campus. She had her intern clean it and butterfly bandage it. She said she was glad I came to her, because if I had gone to the ER, they would have stitched to resolve, and it would have left a scar and been awkward to live with until it healed.

So you may have less of a scar with the butterfly, that's how mine resolved.
posted by effluvia at 1:32 PM on February 28, 2010

How concerned are you with scarring?

If that's an issue at all (a little late now) you should go to a plastic surgeon. Assembling someone's face, to me implies that they should be able to, say, sculpt a small head from clay, for instance. Your average ER doc would fail that test more often than the plastic surgeon.
posted by StickyCarpet at 1:36 PM on February 28, 2010

You might try calling the in-store clinics to see if they will do it, and to find the cost. Near me, there is are RediClinics in our grocery stores. I've been to it (not for stitches), and it was fine (if a little weird). They will do "minor cut closure with Dermabond" for $99. That's just to give you an idea, though, because there doesn't seem to be a RediClinic in Minnesota. However, there are similar clinics:
- Walmart (pdf) has a clinic in their Oak Park Heights store
- CVS has clinics in their Minneapolis/St. Paul area stores
- Target has clinics in their Minnesota stores
posted by Houstonian at 1:47 PM on February 28, 2010

I'd say go to the urgent care center, not the ER.

Data point:

I recently had to go to the ER (in Philly), and through a screw-up in billing, they tried to charge me roughly ten grand. about 5 of that was just for showing up.
posted by chicago2penn at 2:23 PM on February 28, 2010

Your choices from most expensive to least:
--hospital ER (they may not be able to sew it at this point)
--urgent care clinic (ditto...but at least they will clean it and stop the bleeding)
--free clinic (if you have one in your area)
--disinfect it yourself and use steri strips
--sew it yourself (this is how people used to do it in the old days...depends how squeamish/pain averse you are)
posted by MsKim at 2:34 PM on February 28, 2010

If you don't get it stitched nicely, it will scar. It will keep bleeding for a day or two, too, though more slowly once the blood clots over the wound more fully.

I have a 3/4" scar on my chin from a bike accident a few years back. Get it looked at if you value your appearance.
posted by Blazecock Pileon at 2:52 PM on February 28, 2010

-sew it yourself (this is how people used to do it in the old days...depends how squeamish/pain averse you are)

I assume no one is stupid enough to seriously consider this advice but sewing it yourself is probably the best way to end up with a stupendous scar.

Never mind that it's too late to stitch it after 12 hours.
posted by fshgrl at 3:31 PM on February 28, 2010

How are your teeth? When my daughter fell and hit her chin, one of her lower front teeth was a bit bloody looking on the bottom. We called the dentist and he told us to go to the emergency room. Turns out she broke her jaw. Had to have surgury to insert a titanium plate, then keep it wired shut for a week.

I don't know all the symptoms of a broken jaw, but i think it's something you should look up and rule out, if you decide to treat this yourself.
posted by CathyG at 3:58 PM on February 28, 2010

--sew it yourself (this is how people used to do it in the old days...depends how squeamish/pain averse you are)

Uh, watch out with this option. I know someone who went that route and when they finally did see a doctor they ended up with a time consuming non-optional psychiatric evaluation.
posted by StickyCarpet at 4:00 PM on February 28, 2010

If you don't get it stitched nicely, it will scar.

As mentioned above, properly used adhesive bandages will have less scarring. Stitches are only mandatory if you need to separately join several layers of deeper tissue, and the ER guys won't know how to do that anyway. That's a surgeon.

Whatever method you choose to close and stabilize your wound, if you don't want a scar then the NUMBER ONE concern is do not let the wound get REOPENED! Do not put it under the shower, don't go skiing, don't wrestle with your toddler nephew.
posted by StickyCarpet at 4:07 PM on February 28, 2010

Response by poster: Just an update in case someone else ends up in a situation like this and would like to read how I chose to resolve my problem.

In one sentence, my advice is to go to Urgent Care.

At first, I went to St. Joseph's Hospital hoping to go to urgent care. However, the hospital did not have urgent care, only ER care. I was redirected to the ER. I prefaced my situation to the incredibly kind lady by telling her I did not have health insurance. She was so helpful and honest! She told me to go to Urgent Care at a clinic down the street; she said it would be cheaper and faster.

Following her and AskMetafilter's advice, I headed to Urgent Care. It was $75 for the initial visit and I stuck the rest on my Visa.. God only knows how much it will be..

However, it was a really good thing I went. The doctor said it was not only extremely deep (to the bone) but also that it was out turned or some such. Basically, my wound looked like an open pair of lips. When the doctor cleaned it, he discovered quite a bit of black gravel or something that I had not gotten. Then he stitched me up. I'm to report back in a few days to remove the tubing or something.

I also got a tetanus shot. Super important. I was not up to date, which I failed to mention in my question.. Hadn't even occurred to me, really.

When I mentioned I had considered not going to Urgent Care, the doctor said that if it had healed on its own, I would have had the appearance that I was "missing" a chunk of skin. Also, it would have taken days to clot and months to heal and most likely would have become infected.

Thanks guys!
posted by fiasco at 4:08 PM on February 28, 2010 [6 favorites]

Best answer: I'm an Emergency Physician. Pretty much the entirety of this advice is "some guy's experience" or "something I heard once from someone." I'm not here to provide medical advice to you (only the doctor in front of you can do that), but to educate on general principles. While there are no hard and fast rules about closing lacerations, it's usually not after 8 hours for body lacerations and not after 12-24 hours for facial and scalp lacerations. But these are rough estimates, and it's different on a per-patient basis. It depends on the patient, the site, the shape, the depth, and how the accident occurred, to start with. And chin lacerations shouldn't usually be closed with Dermabond or superglue, because it's a high-tension area that will tear open when you talk or chew or yawn.

If that's an issue at all (a little late now) you should go to a plastic surgeon. Assembling someone's face, to me implies that they should be able to, say, sculpt a small head from clay, for instance. Your average ER doc would fail that test more often than the plastic surgeon.

Have to take issue with this. Working in the Emergency Department, I have 100 times more experience suturing unintentional, traumatic lacerations than a plastic surgeon does. Plastic Surgeons do a great job with cosmesis -- don't get me wrong -- but what percentage of traumatic lacerations in the Emergency Department are sutured by me versus someone trained in plastics? I probably repair >95% of them. Plastic surgeons don't sit around in Emergency Departments waiting for lacerations to repair. The stabbings, the crush injuries, the avulsed fingertips, the toddler who fell down, the road rash from motorcyclists, the cuts from shattered glass, the Sunday morning bagel in hand I cut my palm with the knife, the table saw versus forearm: that's an Emergency Physician's domain, unless there are secondary injuries that require more expert repair.

On preview: glad it's repaired!
posted by gramcracker at 4:11 PM on February 28, 2010 [7 favorites]

If you don't get it stitched nicely, it will scar.

Data point: I have had some prior experience due to a 500-stitch car accident when I was younger, and I'm a fairly crafty guy, but the fingertip pad that I reattached myself has no scar or loss of sensation. The 1/2" bicycle accident cut on my chin that the ER fixed has an obvious scar.
posted by StickyCarpet at 4:23 PM on February 28, 2010

When I mentioned I had considered not going to Urgent Care, the doctor said that if it had healed on its own, I would have had the appearance that I was "missing" a chunk of skin. Also, it would have taken days to clot and months to heal and most likely would have become infected.

Good thing you went. Glad to hear you'll be on the mend!
posted by Blazecock Pileon at 4:25 PM on February 28, 2010

One thing to keep in mind: Make sure you put lots of sunscreen on the shiny new skin that grows in. That skin is more sensitive to the sun, and by protecting it I've heard it can make any scarring less noticeable. You have to be diligent about the sunscreen for a long time. I've been told 6 months to a year.

IANAD, just a klutz with lots of experience with scars.
posted by TooFewShoes at 4:27 PM on February 28, 2010

Oops, someone who actually knows what they are talking about just showed up. My point, gramcracker, is what percent of the heroic and admirable work you describe involves the face.

Also, can you sculpt a small clay head? Just curious.
posted by StickyCarpet at 4:28 PM on February 28, 2010

Maybe a picture would have made things clearer, but if they had to dig around for so much gravel that you need a drainage tube, then damn, go to the hospital next time.
posted by StickyCarpet at 4:35 PM on February 28, 2010

Good to see you've already had it treated, however, just in case it helps someone --

"I was coming home from work and slipped on the stairs" sounds like you were probably nearing home when you fell, but if you actually slipped on the stairs in your workplace it would have been covered by workers' comp, most likely.

I took a header down a flight of stairs on my way out of my work building once. A concussion resulted (I was very lucky it wasn't worse), and all the medical treatment was covered by workers' comp because I was still in the building leaving work. I didn't expect that it would be covered since it was after work hours, in a part of the building that was not restricted to our company, and I was on my way home, not doing work functions. But in Washington State at least, it was covered.

I figure your accident must have been closer to home since you didn't mention workers' comp, but maybe not.
posted by litlnemo at 6:20 PM on February 28, 2010

I split my lip and the bridge of my nose last year in a bad fall, and I'd be remiss not to ask, fiasco: did the urgent care guy check your teeth? I loosened my front teeth and required emergency dental work (along with 13 or so really nicely-done stitches from the ER docs). You may want to check into free or reduced-cost dental care in the next few days just to make sure everything's solid in there.
posted by fairytale of los angeles at 10:12 PM on February 28, 2010