Do I need to go to urgent care?
June 15, 2020 7:12 AM   Subscribe

I was sweeping a walkway when the metal broom I was using snapped partially in half, and hinged back and bit a good chunk out of my finger. If at all possible I want to avoid paying for medical treatment. Would this be ok or do I really need to bite the bullet and $eek treatment?

I was sweeping a walkway when the metal broom I was using snapped partially in half, and hinged back and bit a good chunk out of my finger (like what happened to this person:

I haven't taken a picture but the chunk it took out of the underside of my middle right finger was significant and it bled a lot. There is still a flap of skin but it's mostly off. I washed it and held it under running water for several minutes, then slathered it with antibiotic cream and bandaged it. Since then the blood has stayed contained under the bandage. I'm not worried about bleeding too much. The pain is not fun but I can handle it. I'm worried about not being able to avoid a possible infection because the wound is deep.

I am interested in advice, especially from medical professionals, about whether I need to seek medical treatment for this. I can take a picture if needed, but for right now I didn't want to unbandage it and risk it bleeding some more.

I am unemployed and I do not have health insurance (I believe I qualify for Medicaid but my app never progresses and I've tried numerous times to call and can't get through). I DO NOT want to pay out of pocket for whatever it would cost to get treated unless I absolutely have to.

To add to that, I live with my elderly mother who is terrified of coronavirus, so close contact with outside parties is to be avoided if possible. She thinks I should go get stitches but I know she also would be scared if I did this. Covid is still common in our community.

Please let me know how you think I should proceed. Should I go now and get it treated? Should I treat it myself and if so is there something else I should do? Is there more information I need to provide in order to determine this? Can I wait and see if it gets infected and then go later if it does, or would this be too risky?

posted by nirblegee to Health & Fitness (20 answers total)
Best answer: This link has some guidance. I think I would go if it were me, and though COVID risk is real, clinics are being very careful. Is there a free clinic in your area?
posted by pinochiette at 7:23 AM on June 15, 2020 [1 favorite]

Best answer: You might need a tetanus booster.

You will need a tetanus shot if:

-Your wound was caused by something that was clean and your last tetanus shot was longer than 10 years ago.

-Your wound was caused by something that was dirty and your last tetanus shot was longer than 5 years ago.

-You are not sure if your wound was caused by something clean or dirty and your last tetanus shot was longer than 5 years ago.

-You are not sure when you had your last tetanus shot.

-You did not get the first series of tetanus shots (primary vaccination series).

posted by cooker girl at 7:39 AM on June 15, 2020 [12 favorites]

This is not medical advice, but if I can clean something thoroughly and get it to stop bleeding, I personally don't bother getting it checked out. You did not clean this thoroughly! I would probably call an advice nurse at this point, but if I were giving you first aid I'd remove the bandage, rinse the whole thing out with running water, then flush the wound with rubbing alcohol and rebandage it. My understanding is that antibiotic cream is not necessary at this point, and the last time I got a big (four stitches) gash the doctor specifically recommended against it's use for anything larger than a scratch.

I spent enough time in construction, and currently spend enough time working with my hands, that unless it's close to bone or tendon, large and ragged, or keeps bleeding, I rinse it off, flush it with alcohol, and bandage it with tape and gauze.
posted by aspersioncast at 8:02 AM on June 15, 2020 [3 favorites]

I am not a medical doctor, but a guy who has cut the shit out of his hands and arms too many times to count.
When you say "the underside of my finger", do you mean the same side as your palm? Which joint of your finger is it (tip, middle, nearest the hand)?

As mentioned above, you should probably re-wash and re-pack that thing.

I would be more concerned with tendon or nerve damage, depending on where it is. If you poke the skin farther away from your body from the wound, can you feel it? While you're re-washing, maybe make sure you can bend, straighten, and move the finger side to side. The palm-side of your fingers tends to have a pretty good fat pad under the skin - if that's all you gouged, the worry level is lower.
posted by notsnot at 8:28 AM on June 15, 2020

Response by poster: Not meaning to thread-sit but for obvious reasons I need to make a decision on this quickly, so I am actively checking this thread.

I read some stuff online just now that suggests that washing with alcohol is a bad idea. Washing with mild soap and water and bandaging it is preferable.

I didn't think of tetanus. Jeesh. Haven't had a shot in many years.

Yes, I mean the palm side of the finger. I can feel the tip of my finger and I can move fine. There are actually two wounds, one on the top section, which isn't as bad and wouldn't cause me to think about seeking medical care. The other one is deep and has a flap of skin hanging off is the one I am concerned about.

It is similar to this: only across the middle joint.
posted by nirblegee at 8:37 AM on June 15, 2020

Best answer: Cleveland Clinic talks about wounds here:
Notice that they do not recommend alcohol or hydrogen peroxide but do say you should see a doctor for wounds from anything dirty or rusty. Tetanus is not something to mess around with! They also suggest changing the bandage at least once per day.
posted by soelo at 8:38 AM on June 15, 2020 [1 favorite]

Best answer: Chiming in on the advice to use rubbing alcohol on a wound. Please don’t do it! Using alcohol or hydrogen peroxide on an open wound can damage tissue and impede the healing process. Info here.
If you would like to call a nurse line that’s free, I found this one here
posted by Champagne Supernova at 8:39 AM on June 15, 2020 [1 favorite]

Tetanus is incurable as far as I know and will kill you. At least go get a tetanus shot.
posted by Lawn Beaver at 8:52 AM on June 15, 2020 [2 favorites]

Best answer: Popping in to add that tetanus is actually pretty uncommon, the vaccine is often hard to get, and that if you've had a booster in the last decade they usually won't administer one IME.
posted by aspersioncast at 9:09 AM on June 15, 2020

Best answer: I'll just mention that (assuming you are in the U.S.) it is far cheaper to go to an instacare during normal business hours, or typically until maybe 6pm or 7pm?, than to wait and go to the ER after hours. So sometimes it is smarter to make the decision quickly while you still have the option to go to instacare.
posted by flug at 9:15 AM on June 15, 2020

Best answer: That last has not been my experience when I had a cut that needed stitches. The injury you are describing sounds worth getting properly cleaned although wounds with chunks missing are often not stitchable. That said - please do not use hydrogen peroxide or alcohol on a wound - as others have mentioned that will actually impede healing.

If you need a tetanus booster you might even ask about DTP - pertussus is endemic these days and most adults haven't had a booster on any of these. Also be aware you have about a 6 hour window to get stitches typically.
posted by leslies at 9:16 AM on June 15, 2020

Best answer: Before everyone has you terrified about tetanus--it doesn't come from rusty metal, it comes from a bacteria in the dirt near livestock-type animals.
posted by mandymanwasregistered at 9:17 AM on June 15, 2020 [1 favorite]

Response by poster: It's not a puncture wound.

I made an appointment at the minute clinic, which is not taking walk-ins. 3 1/2 hours from now was the earliest I could get :-(

Thanks all.
posted by nirblegee at 9:25 AM on June 15, 2020 [1 favorite]

Best answer: I had a similar wound to my finger a few years ago and I went to an urgent care doc in a box clinic. They cleaned it really thoroughly and bandaged it, said there was no way to stitch it, and gave me some great bandage stuff that doesn't stick. Just dug the last of it out of the medicine cabinet, it's called non-adherent dressing and it's mesh-like.

It's not like like going to the emergency room, I think it cost me around 50 bucks, and it was well worth it. I'd recently had a tetanus shot so that wasn't an issue. Wear a mask, avoid touching things and sitting close to anyone.
posted by mareli at 9:27 AM on June 15, 2020

Best answer: True, rust does not cause tetanus - but tetanus can be present in soil and city dwellers are not immune.
posted by soelo at 9:34 AM on June 15, 2020

Best answer: I had a conversation with a primary care physician a few years ago who was stricken with guilt because she had not followed through on the tetanus shot status of a patient who cut himself on a piece of garden equipment. He went to her office rather than the ER, where she bandaged the wound but didn't administer a tetanus shot. She didn't have the vaccine in her office - I can't remember why - but she strongly advised the patient to go to an urgent care to have it administered. The patient didn't follow through, and didn't get the tetanus shot.

He did, however, get tetanus. And in fact he died of it. This is really, really rare these days because administering tetanus shots in ERs and urgent care offices is reflex after this kind of injury.

This physician has been so upset that she didn't follow up or somehow obtain the vaccine that she has been or a mission ever since to encourage docs to stock tetanus antitoxin and follow-up closely with patients who might need it.

I am very happy to read that you are going to an urgent care! Good luck healing.
posted by citygirl at 2:49 PM on June 15, 2020 [3 favorites]

Best answer: It doesn't have to be a puncture wound to make getting a tetanus shot a good idea. In my experience the tetanus vaccine is readily available. Tetanus germs are actually everywhere and the reason it's a rare disease is because people are generally vaccinated against it. If the broom was dirty, I would definitely make sure I'd had a tetanus booster in the last decade and if not I'd get one, or at least call a nurse hotline to confirm you don't need it.
posted by nantucket at 3:18 PM on June 15, 2020

Response by poster: I did get a tetanus shot, plus a prescription for antibiotics. They didn't do stitches there, and I opted not to go elsewhere to get them done, so she just cleaned the wound with saline and put steri-strips and bandages on it. The whole thing cost about $250 :-( but yeah I'm glad I went so thanks guys. I would not even have thought of tetanus.
posted by nirblegee at 3:21 PM on June 15, 2020 [15 favorites]

And now you don't need to think bout it for another decade. Glad you got fixed up and wish we had universal healthcare so you wouldn't have had to parse the cost of care!

Be prepared for a sore arm for a few days. Not all immunizations cause soreness but tetanus has a rep.
posted by citygirl at 9:43 PM on June 15, 2020

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