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Scalp Laceration

Scenario:
Scalp lacerations are uncommon when helmets are worn properly. Cuts may occur when an overlying branch penetrates a vent hole in the helmet, or when a the biker's head hits sharp rock just below the helmet.

Description:
Most scalp lacerations are caused by a blunt hit. The scalp "bursts" when it's pinched between the skull and another object. If the cut is gaping, it usually does better with stitches. A small scalp cut can be managed at home.

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Concerns:
Scalp cuts usually heal well. Be sure there's no wood or gravel in the wound. If you're concerned about skull fracture or concussion, see the doctor. Signs of serious head injury include: loss of consciousness, confusion, repeating questions, vomiting, severe headache, seizure.

See the doctor if:
    the wound is gaping open
    bleeding does not stop
    significant head injury occurred:
        loss of consciousness
        confusion
        repeating questions
        vomiting
        severe headache
        seizure

Immediate care:
Hold pressure on the cut until bleeding stops. Scalp lacerations can bleed profusely. Put direct pressure on the laceration (ideally with sterile dressing material, but your bike shirt will do). If continued pressure is needed, tie the cloth into place with a sling (triangular bandage). You may be able to maintain pressure by cinching your bike helmet snugly over a cloth compress.

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Carefully assess whether stitches are needed. If you decide to treat at home, make sure the wound is free of dirt and debris. Clean with Betadine, then dry the wound and surrounding hair. Grasp small locks of hair from each side of the cut. Pull them together, crisscrossing over the wound. Either tie or glue the hair locks together.

This is a small scalp cut. We've pulled a small lock of hair from each side across the cut. The bleeding has stopped, and the skin edges match perfectly. Now if we can just keep the cut closed...

Scalp cut resulting from a broken branch penetrating through a ventilation hole in the biker's helmet.

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lacsclp2.jpg (11918 bytes) We blot the area dry then wait a minute (use a blow dryer if necessary) until the hair is dry. While holding the hair in position, we put a drop of superglue so it bonds the two locks of hair together.

The bonded hair forms a "stitch" across the cut. The area must be protected from brushes and combs. After a few days, the glue will break up.

Ongoing care:
Keep the comb and brush away from the area for a few days. Avoid contact sports.

Watch for:
Watch for signs of infection, such as swelling, redness, increasing pain, fever, or drainage. See section on infection. Observe 24 hours for symptoms of serious head injury.

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