Motorbike road rash: the first forty-eight hours

Sand on a corner, a rented scooter, and the whole left side of a forearm and a hip sanded off. It happens somewhere on the coast road every day of the week, and the wound itself is usually not the interesting part. What happens over the following two days decides whether this is a scab or a problem.

This page is deliberately about the first forty-eight hours, because that is the window in which a graze is either cleaned properly or quietly colonised. It is not a substitute for having someone look at it, particularly if any of the signs in the next section apply.

Be seen today, not tomorrow

Some of these need an emergency department rather than a house call. Call 115 or go to the nearest hospital if there is heavy bleeding that firm pressure does not stop, a head injury with vomiting or drowsiness, or if the person is confused, shivering uncontrollably and breathing fast. That combination with a wound can mean sepsis. It is time-critical.

• A wound that gapes, or where fat, muscle, tendon or bone is visible
• Grit, glass or tarmac you cannot flush out, or a flap of skin lifted away
• Numbness past the injury, or a finger, toe or joint that will not move properly through its range
• A limb that looks bent, shortened or rotated, or pain on weight-bearing after a fall
• A graze over a knuckle, a knee or an elbow, where the joint capsule sits close under the skin
• A wound on the face, or anywhere that will scar visibly and needs closing properly
• Diabetes, poor circulation, or medicines that suppress the immune system — the threshold drops a long way

At the roadside

In the first few minutes the useful things are unglamorous. Get off the road, out of traffic. Sit down, because the shake that arrives two minutes later knocks people over. Check that everything moves before worrying about the graze — a broken wrist hides behind a dramatic skin injury surprisingly often.

Press a clean cloth firmly onto anything bleeding. Hold it there rather than lifting it to look. If a helmet took a hit, the head matters more than the arm, and any vomiting, drowsiness or a gap in memory means hospital rather than a dressing.

Take photographs of the scene and the bike before it is moved. That is not legal advice, but once the bike has been moved that evidence is gone.

The wash is the treatment

Road rash is a dirty wound by definition. Nothing applied on top compensates for grit left underneath. The washing is not preparation for the treatment; it is the treatment.

• Wash your own hands first, with soap, before touching anything
• Run clean water over the graze under pressure — a tap, or a bottle squeezed hard. Several minutes, longer than feels reasonable
• Lift out visible gravel and road debris with tweezers cleaned in alcohol. Embedded grit you cannot free is a reason to be seen, not a reason to dig
• Mild soap around the wound edges is fine; inside the raw area, water does the job
• Pat the surrounding skin dry with something clean, leaving the wound surface itself alone

Grit that stays under the surface does two things. It feeds infection. And as the skin heals over it, it tattoos the scar permanently grey. Both are much easier to prevent in the first hour than to fix in the second week.

What not to put on it

• Neat alcohol, iodine straight onto raw tissue, or hydrogen peroxide — all of them kill the healing surface along with the bacteria
• Toothpaste, cooking oil, fish sauce, turmeric paste, chewed leaves, or any of the roadside remedies that will be offered kindly and confidently
• Antibiotic powder bought over a pharmacy counter and sprinkled dry into the wound
• Cotton wool, which sheds fibres into the surface and bonds to it
• Nothing at all, left open, on the theory that air heals it — a graze dries into a hard crust that cracks and reopens

Dressings for the first two days

A graze heals fastest kept slightly moist and covered, not sealed wet and not baked dry. In a hot, humid climate that balance is harder to hold. The dressing gets wet from the inside.

A non-adherent dressing, or a hydrocolloid pad on a smaller area, held with a light bandage rather than tape across broken skin. Change it when it is soaked through or has slid. Otherwise on a schedule somebody set. Not when you happen to remember. Expect a lot of clear or straw-coloured fluid in the first day; that is normal for a large graze and is not pus.

Keep the limb up when you are sitting. Swelling under a dressing is uncomfortable and it slows everything down.

Tetanus, every time

Road surface, soil and animal traffic make this exactly the wound type tetanus cares about. Protection is time-limited. Most travellers genuinely cannot say when their last booster was, which is a reason to check rather than a reason to shrug.

It takes a minute to establish. It is a serious thing to leave out, so it belongs in the first assessment. If you know the date, have it ready. If you do not, the usual approach is to treat the history as uncertain and act accordingly.

Hour by hour, what infection looks like starting

A healing graze is sore, pink at the edge and leaking clear fluid. An infected one changes direction, and the timing is informative.

• Day one: pain easing slowly, redness staying within a finger's width of the edge, fluid clear. This is the expected course
• Day two: pain increasing rather than fading, redness spreading outwards, the skin around it hot and tight
• Thick yellow or green discharge, or a smell when the dressing comes off
• A red line running away from the wound towards the body, following the lymph channels
• A temperature, shivering, or simply feeling systemically unwell when the injury is only skin deep
• Anything that was improving and then reverses on day three or four

Increasing pain after the first day is the single most useful signal, and the one people explain away. Grazes hurt less each day. One that hurts more needs looking at.

Sea, pool and shower

This is the part that undoes good early care. Seawater is not sterile. Warm coastal water carries organisms that do badly by open wounds, and sand works its way under a dressing with determination. A pool adds chlorine to a raw surface, which is uncomfortable and not protective.

So: no swimming while the surface is open, which for a decent graze means more than the two days most people allow. Showering is fine — cover the dressing, keep it brief, change the dressing afterwards if it got wet. A bath that soaks the wound is not.

Scars, and the grit you cannot see

Once the surface has closed, keep it out of direct sun for several months. New skin pigments darkly and unevenly. The coast here supplies more ultraviolet than most visitors are used to. Cover it rather than relying on sunscreen over fresh skin.

If you can see grey or blue flecks under healed skin, that is traumatic tattooing, and it is far easier to remove in the first days than later. It is worth mentioning at the first visit rather than at the last.

Insurance and the police report

Two administrative points that cost people their claim. Many travel policies exclude motorbike injuries unless you held the correct licence for the engine size and were wearing a helmet. Read that clause before you rent. Not after you fall. And if another vehicle was involved, or the bike is damaged, a police report is usually needed. Obtaining one days later is far harder.

Keep every receipt. Ask for the medical report in English, and photograph the wound at each dressing change. A sequence of dated photographs settles questions that paperwork alone cannot.

The short version

Wash it for longer than feels necessary. Get every piece of grit out, cover it with the right dressing, and have somebody look underneath on a set schedule. Stay out of the sea. And treat pain that is increasing on day two as the warning it is — almost every graze that becomes a real problem was a minor one nobody re-examined.