Pink Asks:

Hi there! I’m so glad I’ve found your site and thanks for taking the time to read this. Ok, here goes.

I’m writing about a fifteen-year-old boy who is being abused physically and sexually by his father. One day at school, he tries to commit suicide by slitting his wrists. He becomes scared by the amount of blood, so he leaves the restroom to try to find help. He is found by his teacher and passes out. Now, I know with any kind of suicide attempt, the police are always contacted, and given the all clear for the paramedics.

Jordyn: I think it would depend on the city, county, school district (and whether or not there was a school resource officer) as to the level of police involvement if he just really needs medical attention. I would advise that if this is written about a real place you ensure they have co police response because a paramedic team would be able to handle this call.

Pink: What will the ED staff do to stabilize a patient who has slit their wrists? Is surgery necessary if the wound is pretty deep?

Jordyn: We always look at airway, breathing, and circulation first. If the patient is talking to us then we can quickly check off the first two as at least functional for the time being. As far as circulation the priority is to stop all active bleeding first by direct pressure. Also, does the patient exhibit any vital sign measurements that show he’s suffering from blood loss—which in this case could be increased heart rate, low blood pressure, and also low oxygen levels.

After that, the medical priority for this patient is to further control the bleeding and determine how much blood he’s already lost. Direct pressure is the method used to control the bleeding. Blood work would be done to look at his blood counts to see if he needs any blood replacement. Next would be to look at if he damaged any arteries, tendons, ligaments or nerves during the attempt. Generally, an exam of the function of the fingers can reveal if there is a concern there. For instance, do his fingers have full range of motion? Do any fingers have areas of numbness? Arterial bleeding is very distinct so it’s usually obvious if an artery has been severed. If he has damaged anything that would limit the function of his hand then he would need follow-up evaluation by a hand surgeon for surgery. If there is no damage to the structures as listed, there is a possibility the wound could be closed in the ER as a simple laceration repair.

Pink: Upon discharge, what will the patient be given to take home for treatment of their wound (the slit wrist)?

Jordyn: If the patient gets a simple laceration repair (merely closing the skin even if it takes a lot of stitches) then pain could be managed at home with over-the-counter pain relievers like Tylenol or ibuprofen. If the patient requires surgery, a short course of a narcotic may be given for pain control,    but we also have to look at other factors to determine if this would be wise for the patient (are they a current drug addict or is there continued concern for suicide attempt). If the patient has surgery, then it is up to the surgeon to determine the patient’s home pain relief.

Pink: If a nurse or doctor notices any bruises on the patient’s body, can they examine an unconscious patient?

Jordyn: Yes, an unconscious patient’s skin can be externally examined. In fact, it is often protocol to do so because we are looking for clues as to why the person is unconscious.

Well continue this discussion next post.