What is the recommended management for road rash in urgent care?

From the Guidelines

Road rash management in urgent care should begin with thorough wound cleansing using soap and water or saline solution to remove debris, dirt, and bacteria. The goal of treatment is to promote healing, prevent infection, and minimize scarring.

• Gentle scrubbing with a soft brush may be necessary to remove embedded particles, though this should be done carefully to minimize additional trauma.
• After cleaning, the wound should be irrigated with sterile saline under pressure (using a 19-gauge needle and 35cc syringe) to flush out remaining contaminants.
• Foreign bodies should be removed completely to prevent infection and tattooing of the skin.
• Topical antibiotics such as bacitracin or mupirocin can be applied to prevent infection, followed by covering with a non-adherent dressing like Telfa or petroleum-impregnated gauze.
• The dressing should be secured with gauze wrap or medical tape and changed daily after gentle cleansing.
• For pain management, acetaminophen or NSAIDs like ibuprofen (400-600mg every 6 hours) are typically sufficient.
• Tetanus prophylaxis should be administered if the patient's immunization status is outdated or unknown.
• Patients should be advised to watch for signs of infection including increasing pain, redness, warmth, swelling, or purulent drainage, and to seek follow-up care if these develop.
• Most road rash injuries heal within 2 weeks, though deeper abrasions may take longer and potentially require specialized wound care. None of the provided studies 1 directly address the management of road rash, but general principles of wound care can be applied.

From the Research

Management of Road Rash in Urgent Care

• The management of road rash in urgent care involves a multifaceted approach that includes early debridement and control of infection 2.
• Topical antimicrobials can be beneficial for infection control in wound care, but their disadvantages, such as cytotoxicity and the development of antimicrobial resistance, should be considered 3.
• The use of autologous skin cell suspension devices, such as ReCell®, has shown promise in the treatment of severe road rash, with results comparable to the current standard of care, split-thickness skin grafting 4.

Treatment Options

• Collagenase ointment and polymyxin B sulfate/bacitracin spray have been shown to be effective in achieving a clean wound bed and promoting wound healing in partial-thickness burns 2.
• Silver sulfadiazine cream is another option for the treatment of partial-thickness burns, but it may not be as effective as combination treatment with collagenase and polymyxin B sulfate/bacitracin 2.
• ReCell® autologous skin cell suspension has been used as an independent treatment modality for pain and skin injury secondary to severe road rash, with decreased pain and overall wound improvement reported 4.

Considerations

• The selection of antimicrobials should take into account the potential adverse effects and the development of antimicrobial resistance 3.
• The use of topical antimicrobials should be guided by the severity of the wound and the presence of infection 3.
• Further research is needed to determine the most effective treatment options for road rash in urgent care, including the use of autologous skin cell suspension devices and combination treatments with collagenase and polymyxin B sulfate/bacitracin 4, 2.