Skin tear and traumatic wound care in North County.

Understanding skin tears and traumatic wounds

The first day or two are about bleeding and the flap. Thin skin oozes easily, and a flap that looked pink at the start may stay healthy or may slowly darken as its blood supply fails. After that, location starts to matter. A protected tear on the arm usually makes steady, visible progress: the raw area shrinks, drainage lessens and new pink skin creeps in from the edges. A wound on the shin has more against it, with little padding beneath, fluid that settles around the ankle and sometimes poor blood flow. If a lower-leg wound sits unchanged week after week, it can turn into a chronic ulcer that calls for a different level of care. The trend between visits tells more than any single look.

What the treating clinician looks at

Assessment starts with the story of the injury. The treating clinician asks what the skin struck or what pulled on it, how long ago, how much it bled and what was done first. A fall changes the conversation, because other injuries have to be ruled out. The clinician also asks about diabetes and circulation problems, and about the date of the last tetanus vaccine, particularly when soil, rust or a dirty surface was involved. Those answers shape the plan as much as the wound’s appearance does. A clean tear in a well-nourished person and a contaminated scrape in someone with several health conditions call for different levels of watchfulness.

Arranging this care in North County

People in North County often move between settings without leaving the area: home, a hospital stay after a fall, a spell of rehabilitation, then home again or into assisted living down the road. An injury wound travels with them, and dressing plans tend to get lost at each handoff. Because Gateway arranges care in private homes and in the senior living communities and skilled nursing facilities close by, the same wound orders, records and supply list can follow the person. The treating clinician picks up from the last note instead of starting over.

North County is the name St. Louisans give to the northern part of St. Louis County, roughly the area north of Interstate 70. It takes in Florissant, Hazelwood, Ferguson, Bridgeton, Berkeley, Jennings, Black Jack, Bellefontaine Neighbors and unincorporated Spanish Lake, and it runs north and east to the Missouri and Mississippi rivers. Interstate 270 and Interstate 170 tie these communities together. Many families have lived here for generations, and many longtime homeowners are now older adults. Care arranged at home or in a nearby facility helps them stay close to family, church and neighbors.

When care happens at home

Family caregivers do the daily handling that fragile skin either withstands or does not. A home visit is a good time to ask the treating clinician to watch a transfer, look over the wheelchair or walker, and point out what to change. Common suggestions include:

• Padding on bed rails, table edges and wheelchair leg rests
• Long sleeves, long pants, or soft sleeves made to protect shins and forearms
• Supporting a limb from below with open palms, not gripping it
• Short fingernails and no rings or watches during care
• A plain moisturizer on arms and legs every day
• Clear, well-lit paths, above all at night

Care in skilled nursing and assisted living

In a skilled nursing facility, a skin tear is usually found by an aide or nurse during morning care or after a transfer. The facility documents it, notifies the attending physician and the family, and can refer to Gateway for a wound care visit. The treating clinician assesses the resident at the bedside and writes orders that facility nurses carry out between visits. Findings go back to the attending physician, the director of nursing and the wound nurse, so the chart tells one consistent story. Because many tears happen during bathing, dressing and repositioning, the clinician can also advise on handling and protective measures for that resident.

Signs to tell the clinician about

Infection is the complication clinicians watch for most closely after a skin injury. Report these to the treating clinician or the facility nurse promptly:

• Redness that is spreading outward from the wound
• Skin around it that feels hot, hard or newly swollen
• Thick, cloudy or foul-smelling drainage
• Pain that is rising instead of easing
• Fever, chills or feeling generally unwell

Call 911 if the person becomes confused, very drowsy, short of breath or faint, with or without a fever. Those can be signs that an infection is affecting the whole body and cannot wait for a scheduled visit.

Why primary care matters here

A skin tear is often the visible part of a fall, and a fall usually has causes that can be found. A primary care clinician can check blood pressure lying and standing, review vision and hearing, look at feet and footwear, test strength and balance, and ask about dizziness and nighttime trips to the bathroom. Small findings add up. When Gateway arranges wound care and primary care together, the wound clinician’s account of how the injury happened reaches the clinician who can look into why. Any next steps, such as therapy or equipment, are coordinated alongside the wound visits instead of as a separate errand.

Primary care at home in North County →

How to get started in North County

For a resident of a nursing home, assisted living or memory care community in North County, a request for skin tear and traumatic wound care can come from the family, the resident or the facility’s nurses. Call 314-325-0126 and give us the facility name, the unit or room and the best nurse contact. Gateway speaks with the facility about its process for outside clinicians, confirms availability and coordinates a visit time that fits the resident’s day. After the visit, the treating clinician’s orders are given to facility nursing, and the family contact on file gets an update if the resident has agreed to that.

Christian Hospital, near Interstate 270, and SSM Health DePaul Hospital in Bridgeton are the two hospitals people in North County use most. Gateway is not affiliated with either one. The first days at home after discharge are when dressing questions and supply gaps tend to show up, so it helps to set up follow-up early. Families can call 314-325-0126 before the patient leaves the hospital. Discharge planners can fax referrals to 314-786-7966 with the summary and wound orders. Gateway then confirms which partner clinician can see the patient at the North County address.

• County: St. Louis County, Missouri
• ZIP codes: 63031, 63033, 63034, 63042, 63135, 63136, 63137, 63138, 63134
• Nearby hospitals: Christian Hospital in North County; SSM Health DePaul Hospital in Bridgeton (not affiliated with Gateway)
• Nearby communities: Florissant, Hazelwood, Ferguson, Bridgeton, North St. Louis
• Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in North County

Read the full guide to skin tears and traumatic wounds, or see everything Gateway arranges on the mobile wound care in North County page.

• Diabetic foot ulcers
• Venous leg ulcers
• Pressure injuries and bed sores
• Arterial and mixed wounds
• Non-healing wounds
• Post-surgical wounds
• Reopened (dehisced) surgical wounds
• Surgical site infections
• Wounds with lymphedema
• Skin graft aftercare
• Wound VAC (NPWT) follow-up
• Skin tear and traumatic wound care in Florissant
• Skin tear and traumatic wound care in Hazelwood
• Skin tear and traumatic wound care in Ferguson
• Skin tear and traumatic wound care in North St. Louis

Common questions