Puncture wounds 자상 – Dr. John Sangwon Lee's Pediatric Updates

Puncture wounds

자상

Cause of Puncture wounds

☞ In the US in 2005, 11,000,000 people received emergency room treatment for acute skin injuries.

More than 500,000 of them are burned, 7,300 thousand people were reincarnated, 2 million people have been treated for cuts and punctures It is said that 4,700,000 people are bitten by animals every year. source; NEJM September 2008. p.1037.

A piercing wound caused by piercing a part of the body with a sharp object such as a knife, nail, tree branch, splinter (small piece/splinter) or a gunshot wound is called a Puncture wound.

Rusty and unclean nails, sharp knives, sharp pieces of wood or glass can pierce hands and feet or other parts of the body.

Most cuts are caused by safety accidents, but they can also be caused by injuries by others or by self-injury.

a -epidermis, b-corium, c-subcutaneous tissue, d-hair, sebaceous gland, f- hair elevation muscle, g-hair body, h- sweat gland, i-hair follicle j-capillary vessels, k-peripheral nerve, l-fat in subcutaneous tissue

Type of Puncture wounds

a stab wound in which the entire body of a stabbed body has fallen out of the body
There are also stab wounds that have a stab-shaped entrance, a stab-penetrating path, and a stab-shaped exit like a piercing wound by a bullet.

Some of the stabbed objects remain in the body, others are cut off,

A stab wound in which the entire stabbed object remains in the body.

Shallow stab wounds,

A deep stab wound,
There are penetrating cuts from one side of the torso to the other.

Symptoms signs of Puncture wounds

Symptoms differ depending on the size and type of the stabbed object, the size of the cut, the type of the cut, the cause of the cut, and the part of the body where the cut occurred.

▴Photo 1-42. Fingers festered by a bacterial infection.

The wounded area became festering, swollen, painful, and red.
Copyright ⓒ2011 John Sangwon Lee, MD., FAAP
Some small cuts are stabbed with sharp-end objects such as thorns, nails, and needles, and there are also very large cuts caused by piercing wounds or traffic accidents caused by gunshot wounds.

A thorn, a needle, or a stab caused by a very small object may bleed a little or may not bleed, and the injured body part may not swell or hurt.

When thorns are stuck, you can pull them out with tweezers.

In general, bleeding from small cuts does not occur much, and there is no problem with health.

Internal bleeding in the thoracic or abdominal cavity caused by a stab can be severe, and internal bleeding can cause shock or death

If your hands or feet are stabbed by nails or sharp branches, you may bleed a little, hurt, and swell cut wounds.

Bacterial infections in plantar cuts (plantar cuts) caused by nails can lead to cellulitis (see Plantar cuts).
Osteomyelitis of the foot can also occur due to a cut on the sole of the foot caused by a nail piercing while wearing sneakers.
When a foreign substance is in the cut wound, the infectious disease may develop locally within 2-3 days, and it may cause swelling and pain.

Treatment of puncture wounds

Treatment of small cuts

If part of the stabbed small object remains stuck in the cut wound, carefully pull out the stuck object as much as possible.

After washing the cuts with soapy water, sterilize them with betadine solution disinfectant.
Then, cover the cut with a disposable band-aid and observe.
Alternatively, cover the cut wound with sterile gauze and fix the gauze with a band-aid, or wrap it with a bandage.
In most cases, this first emergency treatment is performed by parents at the accident site.
If parents are not confident to treat cuts at home as described above, or if they need follow-up cuts at the next step after taking first aid at home, receive treatment at a regular pediatrics department or hospital emergency room.

▴ Photo 1-43. Limbs or body with branches or sharp objects When the other part is deeply stabbed, the stabbed object hits the stabbed upper body.

When stuck in place, stabbed objects are cut without instructions from a doctor. You must not pull it out of your upper body. Copyright ⓒ2013 John Sangwon Lee, MD., FAAP ‘

Treatment of Puncture wounds

If an arm, leg, or another part of the body is deeply punctured with a large branch (refer to photo 63) or another large object, the parent will be the first emergency at the accident site as instructed by the hospital emergency room or a regular child and adolescent department as much as possible.

Start treatment.

Before being transported to the hospital emergency room, do not stab the body without the instructions of a doctor, and do the observational treatment as it is in the state of being stabbed, rather than pulling out any sticks or objects.

When there is a stab wound similar to that shown in the above picture 53, when the stabbed object is pulled out, the peripheral nerves and blood vessels in the stabbed wound may be damaged. When the entire stabbed object has come out, emergency treatment is given depending on the severity of the cut.

Even if the cut wound is large, cover it with sterile gauze as much as possible, and if the cut is bleeding a lot, press the bleeding wound directly with your finger or palm to stop the bleeding or stop the bleeding with a tourniquet, and follow the call from a medical paramedic or regular pediatrician to the hospital emergency room
Transfer quickly. On the surface, it is often not clear how large and deep the stab is.
There are times when it is not clear for sure whether all the stabbed wood or glass pieces have come out, and whether some of them remain in the skin layer or subcutaneous tissue.
You can check if there is any foreign body in the punctured area by using an X-ray examination or an ultrasound examination.

출처 및 참조 문헌

Childhood Emergencies in the Office, Hospital, and Community, American Academy of Pediatrics
Emergency Medical Service for Children, By Ross Lab. May 1989. p.10
Emergency care, Harvey Grant, and Robert Murray
Emergency Care Transportation of Sick and Injured American Academy of Orthopaedic Surgeons
Emergency Pediatrics: A Guide to Ambulatory Care, Roger M. Barkin, Peter Rosen
Immediate care of the acutely ill and injured, Hugh E. Stephenson, Jr
The Critically Ill Child, Diagnosis and Management, Edited by Clement A. Smith
Emergency Medical Services for Children: The Role of the Primary Care Provider, American Academy of Pediatrics
Quick Reference To Pediatric Emergencies, Delmer J. Pascoe, M.D., Moses Grossman, M.D., with 26 contributors
Manual of Emergency Care 응급환자관리 정담미디어
소아가정간호백과–부모도 반의사가 되어야 한다, 이상원
Neonatal Resuscitation American Heart Association
Neonatology Jeffrey J.Pomerance, C. Joan Richardson
Pediatric Resuscitation Pediatric Clinics of North America, Stephen M. Schexnayder, M.D.
Pediatric Critical Care, Pediatric Clinics of North America, James P. Orlowski, M.D.
Preparation for Birth. Beverly Savage and Dianna Smith
Nelson Textbook of Pediatrics, 14th ed. Beherman,
The Johns Hopkins Hospital, The Harriet Lane Handbook, 18th edition
Red book 29th-31 edition 2021
Nelson Textbook of Pediatrics, 19th-21st Edition
Infectious disease of children, Saul Krugman, Samuel L Katz, Ann A. Gershon, Catherine Wilfert
The Harriet Lane Handbook, 19th Edition
소아과학 대한교과서
제1권 소아청소년 응급의료 참조문헌과 출처
Other

“부모도 반의사가 되어야 한다” – 내용은 여러분들의 의사로부터 얻은 정보와 진료를 대신할 수 없습니다.

“The information contained in this publication should not be used as a substitute for the medical care and advice of your doctor. There may be variations in treatment that your doctor may recommend based on individual facts and circumstances. “Parental education is the best medicine.”

자상(Puncture wounds)
자상의 원인
☞ 2005년 미국에서는 1,100만 명의 사람들이 급성 피부 손상으로 인해 응급실 치료를 받았습니다.
이 중 50만 명 이상이 화상을 입었고, 730만 명이 타박상 등의 손상을 입었으며, 200만 명이 열상(찢어진 상처) 및 자상(찔린 상처) 치료를 받았습니다. 또한 매년 470만 명이 동물에게 물리는 사고를 겪는 것으로 알려져 있습니다. (출처: NEJM, 2008년 9월호, p.1037)
칼, 못, 나뭇가지, 나무 조각(가시), 총알과 같은 날카로운 물체가 신체의 일부를 뚫고 들어와 발생하는 상처를 자상(Puncture wound)이라고 합니다.
녹슬고 오염된 못, 날카로운 칼, 뾰족한 나무 조각이나 유리 파편 등이 손과 발, 또는 신체의 다른 부위를 뚫고 들어갈 수 있습니다.
대부분의 자상은 안전사고로 인해 발생하지만, 타인에 의한 상해나 자해 행위로 인해 발생하기도 합니다.
a-표피, b-진피, c-피하 조직, d-털, e-피지선, f-기모근(털세움근), g-털줄기, h-땀샘, i-모낭, j-모세혈관, k-말초 신경, l-피하 조직 내 지방
자상의 유형
자상을 입힌 물체(자상기) 전체가 신체에서 빠져나온 형태의 자상
총알에 의한 관통상처럼, 찔린 형태의 입구와 관통 경로, 그리고 찔린 형태의 출구가 모두 존재하는 관통성 자상도 있습니다.
자상기의 일부가 신체 내에 남아 있는 경우도 있고, 일부가 부러져 떨어져 나간 경우도 있습니다.
자상기 전체가 신체 내에 그대로 남아 있는 형태의 자상
표재성(얕은) 자상
심부(깊은) 자상
몸통의 한쪽 면에서 반대쪽 면으로 완전히 관통한 형태의 자상도 있습니다.
자상의 증상 및 징후
증상은 자상기의 크기와 종류, 상처의 크기 및 형태, 상처 발생 원인, 그리고 상처가 발생한 신체 부위에 따라 다르게 나타납니다.
▴사진 1-42. 세균 감염으로 인해 곪은 손가락.
상처 부위가 곪고, 부어오르며, 통증과 발적(붉어짐)을 보였습니다.
Copyright ⓒ 2011 John Sangwon Lee, MD., FAAP
작은 열상(베인 상처) 중에는 가시, 못, 바늘과 같이 끝이 날카로운 물체에 찔려 발생하는 경우가 있으며, 총상이나 교통사고 등으로 인해 발생하는 매우 큰 열상이나 관통상도 있습니다.
가시, 바늘, 또는 아주 작은 물체에 찔린 상처는 출혈이 거의 없거나 전혀 없을 수도 있으며, 다친 신체 부위가 붓거나 통증이 느껴지지 않을 수도 있습니다.
가시가 박혔을 때는 핀셋을 사용하여 뽑아낼 수 있습니다.
일반적으로 작은 열상으로 인한 출혈은 심하지 않으며, 건강상 별다른 문제를 일으키지 않습니다.
날카로운 물체에 찔려 흉강이나 복강 내부에 출혈이 발생한 경우 심각한 상황으로 이어질 수 있으며, 이러한 내부 출혈은 쇼크나 사망의 원인이 될 수도 있습니다.
손이나 발이 못이나 날카로운 나뭇가지에 찔린 경우, 약간의 출혈이 발생하거나 통증을 느끼고 상처 부위가 부어오를 수 있습니다.
못에 찔려 발생한 발바닥 열상(상처)에 세균 감염이 동반되면 봉와직염(연조직염)으로 발전할 수 있습니다(참조: 발바닥 열상).
운동화를 신은 상태에서 못에 찔려 발바닥에 상처가 난 경우, 발의 골수염이 발생할 수도 있습니다.
상처 부위에 이물질이 남아 있는 경우, 2~3일 이내에 해당 부위에 국소적인 감염 증상이 나타나면서 부종과 통증을 유발할 수 있습니다.
자상(찔린 상처)의 처치
작은 열상의 처치
작은 물체에 찔렸을 때 그 일부가 상처 속에 박혀 남아 있다면, 박혀 있는 물체를 조심스럽게 최대한 뽑아내십시오.
상처 부위를 비눗물로 깨끗이 씻은 후, 베타딘(Betadine) 용액 등의 소독제로 소독하십시오.
그다음, 상처 부위를 일회용 반창고(밴드)로 덮고 경과를 지켜보십시오.
또는 멸균 거즈로 상처를 덮은 뒤 반창고로 고정하거나, 붕대로 감아주어도 좋습니다.
대부분의 경우, 이러한 초기 응급처치는 사고 현장에서 보호자가 직접 수행하게 됩니다.
만약 보호자가 위에서 설명한 대로 집에서 상처를 처치하는 데 자신이 없거나, 집에서 응급처치를 마친 후에도 추가적인 진료가 필요하다고 판단될 때는, 일반 소아청소년과나 병원 응급실을 방문하여 치료를 받으십시오.

▴ 사진 1-43. 나뭇가지나 날카로운 물체에 의한 사지 또는 신체 깊숙이 찔린 경우, 찔린 물체가 찔린 상체를 강타합니다.
찔린 물체가 박혔을 경우, 의사의 지시 없이는 잘라내지 마십시오. 절대로 상체에서 뽑아내서는 안 됩니다. 저작권 ⓒ2013 John Sangwon Lee, MD., FAAP
관통상 처치
팔, 다리 또는 신체의 다른 부위가 큰 나뭇가지(사진 63 참조)나 다른 큰 물체에 깊숙이 찔린 경우, 보호자는 가능한 한 병원 응급실이나 일반 소아청소년과에서 지시한 대로 사고 현장에서 응급 처치를 시작해야 합니다.

응급실로 이송하기 전에는 의사의 지시 없이 신체를 찌르지 말고, 막대기나 물체를 뽑아내지 말고 찔린 상태 그대로 관찰 치료를 해야 합니다.

위 그림 53과 같은 자상 발생 시, 자상을 제거할 때 자상 부위의 주변 신경과 혈관이 손상될 수 있습니다. 자상이 완전히 제거된 후에는 상처의 심각도에 따라 응급 처치를 시행합니다.
상처가 크더라도 가능한 한 멸균 거즈로 덮고, 출혈이 심한 경우에는 손가락이나 손바닥으로 출혈 부위를 직접 눌러 지혈하거나 지혈대를 사용하여 지혈하고, 구급대원이나 소아과 의사의 연락에 따라 병원 응급실로 신속하게 이송합니다.
상처의 크기와 깊이는 겉으로 보기에 명확하지 않은 경우가 많습니다.
자상에 박힌 나무 조각이나 유리 조각이 모두 제거되었는지, 피부나 피하 조직에 남아 있는지 확실히 알 수 없는 경우도 있습니다.
이러한 경우 X선 촬영이나 초음파 검사를 통해 자상 부위에 이물질이 남아 있는지 확인할 수 있습니다.

출처 및 참조 문헌
소아 응급 상황(사무실, 병원 및 지역사회), 미국 소아과학회
소아 응급 의료 서비스, Ross Lab. 1989년 5월, 10쪽
응급 치료, Harvey Grant, Robert Murray
환자 및 부상자의 응급 이송, 미국 정형외과학회
소아 응급의학: 외래 진료 안내, Roger M. Barkin, Peter Rosen
급성 질환 및 부상자의 즉각적인 치료, Hugh E. Stephenson, Jr.
중증 아동, 진단 및 관리, Clement A. Smith 편집
소아 응급 의료 서비스: 일차 진료 제공자의 역할, 미국 소아과학회
소아 응급 상황에 대한 빠른 참조, Delmer J. Pascoe, M.D., Moses Grossman, M.D. 외 26명 기고
응급 환자 관리 정담미디어
소아가정간호백과-부모도 반의사가 있어야 한다, 이상원
신생아 소생술, 미국 심장 협회
신생아학 Jeffrey J. Pomerance, C. Joan Richardson
소아 심폐소생술, 북미 소아과 클리닉, Stephen M. Schexnayder, M.D.
소아 중환자 치료, 북미 소아과 클리닉, James P. Orlowski, M.D.
출산 준비, Beverly Savage 및 Dianna Smith
Nelson 소아과 교과서, 14판 베허먼,
존스 홉킨스 병원, 해리엇 레인 핸드북, 18판
레드 북 29~31판 2021
넬슨 소아과 교과서, 19-21판
어린이 전염병, Saul Krugman, Samuel L Katz, Ann A. Gershon, Catherine Wilfert
해리엇 레인 핸드북, 19판
어린이과학대한교과서
제1권 아동청소년 신청의 료 참조 문헌 출처
다른
Copyright ⓒ 2015 존 이상원 MD., FAAP
“부모님 반의 사수가 되어야 합니다” – 내용은 여러분의 의사로부터 얻은 정보와 제멋대로를 대신할 수 없습니다.
“이 출판물에 포함된 정보는 담당 의사의 진료 및 조언을 대신할 수 없습니다. 담당 의사가 개별 사실과 상황에 따라 권장할 수 있는 치료법에는 차이가 있을 수 있습니다. “부모 교육이 최고의 약입니다.”
저작권은 drleepediatrics.com에 있으며, 2026년 3월 15일에 등록되었습니다.

Puncture wounds

자상

Cause of Puncture wounds

☞ In the US in 2005, 11,000,000 people received emergency room treatment for acute skin injuries.

More than 500,000 of them are burned, 7,300 thousand people were reincarnated, 2 million people have been treated for cuts and punctures It is said that 4,700,000 people are bitten by animals every year. source; NEJM September 2008. p.1037.

A piercing wound caused by piercing a part of the body with a sharp object such as a knife, nail, tree branch, splinter (small piece/splinter) or a gunshot wound is called a Puncture wound.

Rusty and unclean nails, sharp knives, sharp pieces of wood or glass can pierce hands and feet or other parts of the body.

Most cuts are caused by safety accidents, but they can also be caused by injuries by others or by self-injury.

a -epidermis, b-corium, c-subcutaneous tissue, d-hair, sebaceous gland, f- hair elevation muscle, g-hair body, h- sweat gland, i-hair follicle j-capillary vessels, k-peripheral nerve, l-fat in subcutaneous tissue

Type of Puncture wounds

a stab wound in which the entire body of a stabbed body has fallen out of the body

There are also stab wounds that have a stab-shaped entrance, a stab-penetrating path, and a stab-shaped exit like a piercing wound by a bullet.

Some of the stabbed objects remain in the body, others are cut off,

A stab wound in which the entire stabbed object remains in the body.

Shallow stab wounds,

A deep stab wound,

There are penetrating cuts from one side of the torso to the other.

Symptoms signs of Puncture wounds

Symptoms differ depending on the size and type of the stabbed object, the size of the cut, the type of the cut, the cause of the cut, and the part of the body where the cut occurred.

▴Photo 1-42. Fingers festered by a bacterial infection.

The wounded area became festering, swollen, painful, and red.

Copyright ⓒ2011 John Sangwon Lee, MD., FAAP

Some small cuts are stabbed with sharp-end objects such as thorns, nails, and needles, and there are also very large cuts caused by piercing wounds or traffic accidents caused by gunshot wounds.

A thorn, a needle, or a stab caused by a very small object may bleed a little or may not bleed, and the injured body part may not swell or hurt.

When thorns are stuck, you can pull them out with tweezers.

In general, bleeding from small cuts does not occur much, and there is no problem with health.

Internal bleeding in the thoracic or abdominal cavity caused by a stab can be severe, and internal bleeding can cause shock or death

If your hands or feet are stabbed by nails or sharp branches, you may bleed a little, hurt, and swell cut wounds.

Bacterial infections in plantar cuts (plantar cuts) caused by nails can lead to cellulitis (see Plantar cuts).

Osteomyelitis of the foot can also occur due to a cut on the sole of the foot caused by a nail piercing while wearing sneakers.

When a foreign substance is in the cut wound, the infectious disease may develop locally within 2-3 days, and it may cause swelling and pain.

Treatment of puncture wounds

Treatment of small cuts

If part of the stabbed small object remains stuck in the cut wound, carefully pull out the stuck object as much as possible.

After washing the cuts with soapy water, sterilize them with betadine solution disinfectant.

Then, cover the cut with a disposable band-aid and observe.

Alternatively, cover the cut wound with sterile gauze and fix the gauze with a band-aid, or wrap it with a bandage.

In most cases, this first emergency treatment is performed by parents at the accident site.

If parents are not confident to treat cuts at home as described above, or if they need follow-up cuts at the next step after taking first aid at home, receive treatment at a regular pediatrics department or hospital emergency room.

▴ Photo 1-43. Limbs or body with branches or sharp objects When the other part is deeply stabbed, the stabbed object hits the stabbed upper body.

When stuck in place, stabbed objects are cut without instructions from a doctor. You must not pull it out of your upper body. Copyright ⓒ2013 John Sangwon Lee, MD., FAAP ‘

Treatment of Puncture wounds

If an arm, leg, or another part of the body is deeply punctured with a large branch (refer to photo 63) or another large object, the parent will be the first emergency at the accident site as instructed by the hospital emergency room or a regular child and adolescent department as much as possible.

Start treatment.

Before being transported to the hospital emergency room, do not stab the body without the instructions of a doctor, and do the observational treatment as it is in the state of being stabbed, rather than pulling out any sticks or objects.

Transfer quickly. On the surface, it is often not clear how large and deep the stab is.

There are times when it is not clear for sure whether all the stabbed wood or glass pieces have come out, and whether some of them remain in the skin layer or subcutaneous tissue.

You can check if there is any foreign body in the punctured area by using an X-ray examination or an ultrasound examination.

출처 및 참조 문헌

Childhood Emergencies in the Office, Hospital, and Community, American Academy of Pediatrics

Emergency Medical Service for Children, By Ross Lab. May 1989. p.10

Emergency care, Harvey Grant, and Robert Murray

Emergency Care Transportation of Sick and Injured American Academy of Orthopaedic Surgeons

Emergency Pediatrics: A Guide to Ambulatory Care, Roger M. Barkin, Peter Rosen

Immediate care of the acutely ill and injured, Hugh E. Stephenson, Jr

The Critically Ill Child, Diagnosis and Management, Edited by Clement A. Smith

Emergency Medical Services for Children: The Role of the Primary Care Provider, American Academy of Pediatrics

Quick Reference To Pediatric Emergencies, Delmer J. Pascoe, M.D., Moses Grossman, M.D., with 26 contributors

Manual of Emergency Care 응급환자관리 정담미디어

소아가정간호백과–부모도 반의사가 되어야 한다, 이상원

Neonatal Resuscitation American Heart Association

Neonatology Jeffrey J.Pomerance, C. Joan Richardson

Pediatric Resuscitation Pediatric Clinics of North America, Stephen M. Schexnayder, M.D.

Pediatric Critical Care, Pediatric Clinics of North America, James P. Orlowski, M.D.

Preparation for Birth. Beverly Savage and Dianna Smith

Nelson Textbook of Pediatrics, 14th ed. Beherman,

The Johns Hopkins Hospital, The Harriet Lane Handbook, 18th edition

Red book 29th-31 edition 2021

Nelson Textbook of Pediatrics, 19th-21st Edition

Infectious disease of children, Saul Krugman, Samuel L Katz, Ann A. Gershon, Catherine Wilfert

The Harriet Lane Handbook, 19th Edition

소아과학 대한교과서

제1권 소아청소년 응급의료 참조문헌과 출처

Other

Copyright ⓒ 2015 John Sangwon Lee, MD., FAAP

“부모도 반의사가 되어야 한다” – 내용은 여러분들의 의사로부터 얻은 정보와 진료를 대신할 수 없습니다.

“The information contained in this publication should not be used as a substitute for the medical care and advice of your doctor. There may be variations in treatment that your doctor may recommend based on individual facts and circumstances. “Parental education is the best medicine.”

Copyright drleepediatrics.com 3/15/2026