Extensive hematoma. Hematoma - a great medical encyclopedia. The mechanism of bruising

A hematoma is a localized blood clot under the skin that may be reddish-bluish and form a swelling on the surface (bruising). Usually a hematoma appears as a result of a blow with a blunt object, which leads to rupture blood vessels and hemorrhage. Large hematomas are dangerous because they expose the blood vessels strong pressure which can slow down circulation. Although in case of a serious injury it is imperative to see a doctor, it is equally important to treat a hematoma at home.

Steps

Part 1

Rest and try not to move the injured body part. Muscle activity and movement can increase pressure on blood vessels in soft tissues, often leading to inflammation. If possible, try to move as little as possible for the next 48 hours after the injury.

• It is best to lie in a natural position (for example, on your back with your arms and legs outstretched). This will allow the hematoma to heal faster and prevent complications. This applies primarily to the limbs and joints.

1. Apply a cold compress to the affected area as soon as possible. You should apply ice to the hematoma as soon as you notice it, but no later than 24-28 hours after the injury. Low temperatures slow down blood circulation, and this stops bleeding. Do not press a cold compress on the skin for more than 15 to 20 minutes, as this can cause tissue damage.

   • Wrap a few ice cubes in a wet towel (18-27°C) and apply to the bruised area for 10 minutes. Repeat the procedure 4-8 times a day to reduce local temperature 10-15 degrees.
   • Cold constricts blood vessels, reduces puffiness and prevents blood from pooling under the skin. Applying a cold compress immediately after an injury helps stop bleeding and shrinks the area of ​​the hematoma.
   • Cold also slows down the local metabolic process in tissues and reduces the risk of hypoxia (that is, cell death from lack of oxygen).

2. Position the bruised area on a raised platform. This is especially important if you have injured a limb. Placing the injured area in an elevated position will slow down the blood circulation in this area, which will not allow the hematoma to increase. Place pillows or blankets under the limb.

   • The site of injury should be above the level of the heart. This reduces local capillary pressure and pressure in the tissues, relieves swelling, promotes lymphatic drainage and the breakdown of waste secretions in the blood.

3. Attach to injury warm a compress if more than 24–48 hours have passed since the injury. Use a heating pad or towel soaked in warm water. The compress should not be hotter than 37–40 °C. Unlike cold, heat is better for the recovery process because it dilates blood vessels, improving blood circulation, which allows important substances to enter damaged tissues and promote the healing process.

   • The increased blood flow also carries away substances that can cause inflammation from the bruise. In addition, heat reduces pain: warm compress suppresses irritating processes in damaged tissues, and this masks pain.
   • Remember: a warm compress should not be applied in the first hours after an injury. Vasodilation will only harm you. You should also not massage the bruise and take alcohol, as this will expand the blood vessels and speed up blood circulation.

4. You can expand the vessels only after a while after injury (at least 24 hours, ideally more than 48). Hematoma can be treated in the following ways:

   • warm bath. Take a warm bath. Like a compress warm water It will also contribute to the expansion of blood vessels, which will help not only reduce pain, but also get rid of blood clots by improving blood circulation.
   • Isotonic exercises. It is necessary to contract and relax the muscles at the site of injury (flexor and extensor muscles) with moderate speed and force. These muscle contractions increase blood circulation by rhythmically constricting the blood vessels, which in turn improves circulation.

5. Take pain medication. To relieve pain, take paracetamol. Do not take ibuprofen or acetylsalicylic acid(aspirin), as they impair blood clotting and prolong bleeding.

   Consider RICE treatment to speed up the healing of the hematoma. RICE is an acronym used in the treatment of injuries: Rest - rest, Ice - ice, Compression - compression, Elevation - lifting. Do not exercise the injured limb and apply ice packs to the hematoma for 48 hours after the injury to reduce inflammation. When not applying a compress, apply a compression bandage to the injury site so as not to disrupt blood circulation. Swelling can be reduced by holding the limb above the level of the heart - for example, you can lie down and put a pillow under the damaged area.

   • Do not massage the hematoma, otherwise the clot may move and enter the bloodstream, which is very dangerous.

   Part 2

   Diet correction

   1. Eat more protein. Protein will speed up tissue repair. As a rule, animal foods contain much more protein than plant foods. Here are some examples of protein foods, ranked in descending order of protein content:

      • whey protein isolate (undenatured, maximum pH);
      • Tuna;
      • wild salmon;
      • halibut;
      • poached egg;
      • turkey breast;
      • cottage cheese;
      • chicken breast.

   2. Consume enough vitamin B12. Deficiency of this substance contributes to the formation of hematomas, the development of anemia and negatively affects blood clotting. Vegetarians are at risk because plants do not contain vitamin B12. If you do not eat meat, take this vitamin in tablets.

      • Vitamin B12 is found in a wide variety of protein foods, including organ meats (beef liver), shellfish, poultry, eggs, milk and dairy products, and some cereals and cereals.

   3. Don't forget vitamin C. Sufficient intake of this vitamin daily will help tissues form new connections and repair themselves. This is especially important for the walls of blood vessels. Talk to your doctor about which vitamin C supplements you should take.

      Pay attention to vitamin K. Deficiency of this vitamin is rare among adults. However, a lack of vitamin K is often the result of poor absorption of fats and / or manifests itself as side effect some antibiotics. Vitamin K deficiency leads to poor blood clotting and hemorrhagic diseases. Talk to your doctor if you think you are deficient in this vitamin.

      • The source of vitamin K is green tea, leafy vegetables (cabbage, spinach, parsley), broccoli, cauliflower and Brussels sprouts, liver, soybean oil and wheat bran.
      • Sourdough dairy products, including yogurt, cheese, soy cheeses, also contain menaquinone (vitamin K2).

   4. Drink more water. To improve blood circulation and speed up healing, it is important to maintain water balance organism. Personal norm depends on weight, height, activity level and general health. In general, men are recommended to drink 15.5 glasses of water per day (3.7 liters), and women - 11.5 glasses (2.7 liters).

      • It is best to drink water. You can also drink unsweetened fruit juices and decaffeinated teas in moderation, but water should be the base.

   5. Add turmeric to your food. It has anti-inflammatory and antiseptic properties that inhibit infections. Turmeric contains essential oils that improve blood circulation and increase the amount of red blood cells. Due to this, the hematoma resolves faster.

   Part 3

   Types and symptoms of hematomas

   1. Determine what type your hematoma is. The term "hematoma" means a blood clot with outside blood vessels. Usually the clot is liquid and is located in the tissues. If the size of the hematoma exceeds 10 millimeters in diameter, it is called a bruise or hemorrhage. There are many types of hematoma, and they can occur in different parts of the body. The main types are:

      • subcutaneous hematoma. It is located directly under the skin.
      • Cephalohematoma. This is a hematoma between the skull and the periosteum (the membrane that covers the outer surface of the bones).
      • epidural hematoma. This hematoma occurs in the dura mater (one of the membranes of the brain and spinal cord).
      • subdural hematoma. It is located in the arachnoid membrane (in the second shell of the brain and spinal cord).
      • Subarachnoid hematoma. It occurs in the pia mater (deep membrane of the brain and spinal cord).
      • Perianal hematoma. Such a hematoma occurs at the border of the external and inside anus.
      • Subungual hematoma. This is a very common type of hematoma.
   2. • Poor blood clotting. Patients with diabetes and hemophilia often find numerous hematomas on their bodies, because their blood does not clot well or does not clot at all.
      • Working conditions. Work that involves a risk of injury (for example, at a construction site) increases the risk of getting a hematoma. Most often, injuries occur at the workplace, leading to subcutaneous and subungual hemorrhages.
      • Age. Older people and small children are more prone to hematomas because they have weak blood vessels.
      • Excessive drinking. Long periods of chronic alcohol consumption make a person prone to bruising. Alcohol dilates blood vessels, making them easier to damage.
      • Unnatural childbirth. If a vacuum extractor is used during childbirth, the infant may develop a cephalohematoma. Too long the second phase of labor can also lead to such a hematoma.

Hematoma is a post-traumatic accumulation of blood inside the human body, resulting from a rupture of blood vessels (for example, with bruises). Hematomas are small and compress soft tissues and nearby organs. They can be localized under the skin, mucous membranes, in the thickness of the muscles, in the wall of internal organs, in the brain, etc. Small hematomas usually resolve on their own. Large hematomas can occur with the formation of connective tissue, disrupt the functions of adjacent organs, or suppurate. Especially dangerous are intracranial hematomas, which cause compression of the brain and can cause the death of the patient. Treatment of hematomas is usually surgical, conservative therapy is less commonly performed.

Classification of hematomas.

There are several classifications of hematomas:

By localization: subcutaneous, submucosal, subfascial, intermuscular hematomas. In addition, hematomas are isolated, which are localized in the tissues of internal organs, as well as in the cranial cavity.

In relation to the vessel: non-pulsating and pulsating hematomas.

By physical condition blood in the area of ​​injury: fresh (without clotting), clotted, infected, hematomas with suppuration.

According to clinical signs: diffuse, limited and encysted hematomas. AT separate group intracranial hematomas (subdural, epidural, intraventricular, intracerebral and subarachnoid hemorrhages) should be distinguished, which differ from all other types of hematomas in terms of clinical signs, course features and possible consequences for the patient's life.

Causes and risk factors.

In most cases, the cause of hematoma development is post-traumatic internal bleeding resulting from impact, blast, compression, infringement and other injuries. An exception to general rule is a subarachnoid hemorrhage, which can occur not only as a result of trauma, but also as a result of non-traumatic damage to the vessel. Sometimes hematomas (usually small) develop in some diseases, one example of such a pathology is Mallory-Weiss syndrome (cracks in the lower esophagus or upper stomach due to vomiting when drinking alcohol or overeating). Among the factors that affect the frequency development and volume of the hematoma, include a violation of vascular permeability, increased fragility of the vascular wall, as well as a deterioration in blood clotting. The likelihood of infection and suppuration of the hematoma increases with a decrease in the body's defenses due to exhaustion, chronic disease, old age and disorders of the immune system.

Subcutaneous hematomas

There are the following stages:

Light. Usually a hematoma appears quickly, within 24 hours from the moment of injury. It is characterized by mild or moderate pain in the area of ​​injury without impaired limb function. Dissolves on its own.

Average. This hematoma appears after 3-5 hours. after injury. Characterized by moderate pain and swelling with partial dysfunction of the limb. Such an injury requires evaluation by a traumatologist to determine management tactics.

Heavy. This hematoma appears within 1-2 hours after traumatization. Characterized by severe pain, significant swelling and loss of function of the limb. This injury urgently needs qualified trauma care.

Whatever the hematoma is, it is accompanied by swelling and infiltration of the injury site. First, the area above the lesion becomes hyperemic, becomes red, and subsequently, as a result of stagnation of blood, it acquires a cyanotic-bluish hue. With an unauthorized breakthrough of a hematoma, infection and suppuration can occur, since blood is an excellent breeding ground for the reproduction of microorganisms. Usually, the treatment of subcutaneous hematomas is conservative and does not require surgical intervention. First of all, it is necessary to apply cold to the injury site, which is subsequently changed to a pressure bandage. pain syndrome it would be justified to use tableted analgesics and anti-inflammatory drugs with Pill-Pack of a fighter and Troxevasin gel to lubricate the impact site and hematoma.

With large extensive hematomas, the subcutaneous space is first drained, then a pressure bandage is applied.

Intramuscular hematomas

The main difference from a subcutaneous hematoma is the depth of placement, and other symptoms (especially in the depth big muscles) local signs are somewhat different: infiltration and swelling are in deeper layers, which reduces the effectiveness of palpation diagnosis. Instead of local edema, an increase in the volume of the limb is noted. Hematoma can usually be diagnosed based on the appearance of the lesion site and clinical manifestations. Treatment of minor hematomas consists in the use of anti-inflammatory and angioprotectors (Troxevasin ointment, Lyoton gel). Large hematomas require immediate fasciotomy and surgical treatment because they are dangerous for the development of anaerobic infections.

Encapsulated hematomas

If the blood does not impregnate the tissues, but forms a cavity, this is called an encysted hematoma. The danger of this type of hematoma is that, if left untreated, it usually does not disappear without a trace, but thickens due to the accumulation of fibrin and calcium salts, or suppurates, especially with injuries with damage skin integrity (abrasions). Large and encysted hematomas need to be opened and drained to speed up recovery, prevent suppuration and complications. The expediency and necessity of opening a hematoma should be determined only by a physician, because sometimes a festering dangerous hematoma can be small and not attract the attention of a field paramedic. Small hematomas can also be drained into honey. parts. Large, extensive, deep and suppurating are indications for hospitalization. Surgeons should open hematomas, but non-purulent hematomas can be eliminated by a traumatologist. All manipulations are carried out using local anesthesia. After infiltration of the anesthetic, an incision is made in a conditional area of ​​the center of the hematoma, blood clots are removed, and the resulting cavity is washed. Chlorhexidine or hydrogen peroxide is good for washing. With regard to suturing wounds, the key signs here are infection of the hematoma. If the wound is clean, it is sutured with tubular drainage and tightly bandaged to prevent postoperative hematoma. The sutures are usually removed on the 7th-10th day. As for infected wounds, we treat them like any purulent wounds in field surgery (drainage without suturing, antibiotic therapy is mandatory).

Subungual hematoma

A subungual hematoma is an injury that can be endured as a separate item, because although it is not critical in terms of deterioration in vital signs or body functions, it causes significant pain and discomfort, and it is also very common in military personnel. . Usually, an injured fighter will come to the medic with a limb raised, because this way his pain is significantly reduced. The concept of subungual hematoma refers to the presence of a post-traumatic blood clot under the nail plate. It can appear as a result of an impact, a concussion wave, or even wearing uncomfortable shoes, or underlacing of berets. Sometimes severe injury causes the nail to fall off. In the field, it is recommended to wash the wound with chlorhexidine and cover with sterile gauze with antibiotic ointment. In other cases, we must provide help to the fighter, since his ability to act will drop significantly. This manipulation is carried out only by a physician. To exit the hematoma and reduce pressure, you need to make a hole in the center of the nail plate (usually, this is where the most blood accumulates.) This manipulation requires a paper clip, a multitool and a lighter. First, do not forget to fix the fighter and distract his attention with something. Next, with a red-hot “sharp” part of the paper clip, we point-burn the nail plate, without excessive pressure and failures. For successful manipulation, remember to rest the edge of your palm on the table before lowering the hot paperclip. This procedure is not very painful, because there are no painful nerve endings in the nail plate. After that, you need to apply a sterile wet bandage.

Intracranial hematomas

By localization, intracranial hematomas are divided into epidural (between the dura and the skull), subarachnoid (in the subarachnoid space), subdural (between the arachnoid and dura meninges), intraventricular (in the cavities of the ventricles of the brain) intracerebral (in the tissues of the brain). Intracerebral and intraventricular hematomas are quite rare due to injuries, usually with severe TBI. Probably the most reliable symptomatology of intracranial hematoma after trauma is loss of consciousness, as well as a typical "light interval" (a period of well-being), "hypertonic" headache, vomiting, psychomotor agitation. There is also bradycardia, hypertension, difference in blood pressure readings on the right and left hands, anisocoria, epileptic seizures. Pyramid symptoms appear (pathological reflexes indicate damage to the central neurons of the cortex). The severity of symptoms directly depends on the size of the hematoma and the location of the lesion. This damage occurs in 0.4-7.5% of cases of traumatic brain injury. This is a rather dangerous localization of the hematoma. Mortality with such damage reaches 60-70%.

According to the rate of increase in symptoms, there are three types of hematomas:

Acute. Short light interval (from several hours to 1-2 days).

Subacute. Symptoms of hematoma appear after 3-4 days.

Chronic. Long light interval (from several weeks to several months).

Bleeding is usually caused by ruptured arteries or veins in the affected area. Symptoms vary depending on the age of the patient, the severity of TBI and the location of the lesion. Initially, there are complaints of headache, then vomiting without relief, seizures, paresis are also possible, there may be respiratory disorders, speech disorders. Sometimes a sign may be pupil dilation on the affected side. In severe cases, coma may develop.

The diagnosis of intracranial hematoma is made on the basis of a questioning of the victim, if he is unconscious, then one of the accompanying persons is interrogated, focusing on the circumstances, the light interval, neurological symptoms and data additional research.All wounded with head injuries undergo an x-ray of the skull in two projections. However, the most reliable for diagnosis is CT, MRI and echoencephalography.

Such hematomas are treated surgically in neurosurgery. Blood clots are removed with an aspirator, the cavity is washed and the source of bleeding is removed. In the future, all the wounded will receive rehabilitation therapy, the duration of which depends both on the size and location of the hematoma, and on the time during which the wounded was taken to the hospital. Character neurological disorders depends on the severity of the injury and the degree of damage to various brain structures.

The medical status of the painful spot is a hematoma. Is a bruise with a blurry outline so harmless? What do “long-playing” bruises testify to? How to calm the pain? Marina Kurzhanskaya, a surgeon at the Unitary Enterprise “24th City Polyclinic for Special Medical Examinations,” helped the portal browser find answers to these serious questions.

Why does a person turn into a "leopard"

Habitual subcutaneous hemorrhages occur as a result of a bruise. A sudden blow leads to damage to blood vessels. The "released" blood spreads and causes swelling - a slight swelling of the soft tissues. Hematomas often appear in older people. At a respectable age, the process of thinning of the connective tissue is activated, in addition, the vessels lose their elasticity.

With the onset of the holiday season, the risk group is replenished by vacationers. Lovers of "smoking" on tropical beaches forget about the sense of proportion. Burnt skin is prone to unsightly marks.

Avid athletes treat bruises with disdain. Annoying "little things in life" - the everyday consequence of training. But constant microtrauma of the limbs leads to a weakening vascular network, and in the future - and to varicose veins.

Another reason for the unpleasant "spotting" is the notorious beriberi. Frequent bruising can signal a deficiency of vitamins C and K. In some cases, a lack of vitamin K leads to a violation of blood clotting.

Unsightly bruises "haunt" patients who abuse antipyretics and painkillers. Load doses aspirin, ibuprofen, paracetamol cause blood thinning.

Don't miss the clinic

It is very dangerous to ignore the doctor's office if you have received an impressive bruise after a serious injury. Seek immediate medical attention for a painful hematoma that restricts joint movement.

Annoying bruises sometimes do not "fade" even after two months. It is not uncommon for bruising to occur without "bumping into life's obstacles." In this case, it is better to contact not only a traumatologist or surgeon, but also a hematologist. A doctor who treats blood diseases will refute or confirm the suspicion of thrombocytopenia. This is a bleeding disorder in which platelet function is inhibited. Weakened "fast response" cells cannot timely close the site of vascular damage and block bleeding.

Anxiety disorder is usually congenital. But there is a "hidden threat" in difficult situations - with injuries, during surgery or childbirth.

A vigilant patient should be alerted by a large postoperative hematoma. A tumor-like bruise is a good reason for a medical consultation.

How to "neutralize" an ordinary bruise

Trivial hematomas after bruises heal with different speed. A harmless bruise on the face disappears after 7-9 days. "Dubious decoration" on the body lasts about two weeks. Extreme "longevity" is distinguished by bruises on the legs. The lower limbs sometimes keep traces of blows for a month. Vessels of the legs experience great blood pressure and become more vulnerable, so bruises are in no hurry to leave their “familiar place”.

During the first three days after the bruise, a “low temperature regime” is recommended. Apply a cold compress to the injured area. At first, the injured limb should be kept in vertical position. This is necessary to reduce swelling. After the fifth day, you can change medical tactics. For resorption of the hematoma, it is useful to use warm baths.

A harmless bruise should completely "dissolve" after a few weeks. During this period, it will change many shades: from purple-blue to yellow-green. If the “rainbow effect” is not observed, you should immediately consult a doctor. Persistent redness and swelling may indicate an infection.

Medical treatment must be prescribed by a doctor. "False Doctor Internet" and folk remedies often do a disservice. On the Web, it is easy to find bad advice like this: "Immediately tighten the bruised area with an elastic bandage." An amateur recommendation can slow down the recovery process for a long time. Non-professional well-wishers are advised to take a large number of vitamins to strengthen the walls of blood vessels and prevent hematomas. But hypervitaminosis is no less dangerous than a lack of nutrients. Excessive intake of vitamin C sometimes leads to the formation of kidney stones.

Effective lotions using bodyagi should be used with caution. In some cases, unpleasant dermatitis occurs. Popular lead lotions "outlawed" with individual contraindications. Accelerate the disappearance of edema iodine nets, which are applied to the skin before bedtime. This simple procedure is not suitable for patients with hyperthyroidism.

Doctors do not call on people to "sound the alarm" over trifles and run to the first-aid post at the slightest scratch. But a reasonable attitude to one's own health will help to avoid not only bruises, but also dangerous “blows of fate”.

Hematoma (from Latin haemat - blood, oma - tumor) is a term denoting a local accumulation of blood in the human body. It is formed due to direct impact injury. Concomitant factors are vascular pathologies and blood diseases: platelet purpura, hemophilia type (A) and type (B), von Willebrand disease. subcutaneous hematoma – most common manifestation given state, less often there are hematomas of internal organs, their walls.

A subcutaneous hematoma is characterized by a small, circumscribed protrusion above the skin that is dark blue or purple. The boundaries are not even and not clear. Sharply painful on palpation, it can hurt even at rest.

Due to action etiological factor blood flows out of the damaged vessel, which enters the skin, subcutaneous tissue and muscles. In each of the above structures there are partitions, trabeculae. They form the so-called anatomical reservoirs into which blood flows. As they fill up, the pressure in the reservoir increases and thereby compresses the bleeding vessel. The blood flow in the occluded vessel slows down, and this leads to the formation of a blood clot and blockage of the damaged artery or vein. A reservoir filled with blood can compress the nerve endings, which leads to pain.

Internal hematoma is much more dangerous than subcutaneous. Pathogenesis and etiology are the same for all types of such manifestations. Most often appears in organs such as the brain, liver, kidneys. The clinical picture depends on the organ in which the hematoma appeared, on its size. The essence of the problem lies in the compression of the organ by accumulated blood.

The hematoma resolves for a very long time. Throughout the time, it changes its color from darker to lighter. This phenomenon is called "blooming", it occurs due to the breakdown of hemoglobin in the blood, which formed a hematoma.

Symptoms

One of the earliest and longest symptoms is pain. There is pain after swelling, it may have a pulsating or pulling character. The intensity of the pain depends on what nerve endings succumbed to compression.

During an injury, many cells are destroyed, in other words, alteration occurs. When a cell dies, many biologically active substances (BAS) are released, which irritate the receptors and cause a burning sensation and itching. Patients complain of a decrease in the function of nearby muscles, the appearance of limited edema. Due to the release of biologically active substances into the blood, the body temperature rises to subfebrile numbers. An old hematoma during decay can also raise body temperature.

If the swelling does not disappear for a long time, and the bruise does not change color, you need to see a doctor. This can be observed when bacteria multiply in the cavity formed by the hematoma. If a hematoma appears after a blow to the head, in addition to pain, as a rule, symptoms of damage to the central nervous system are observed: nausea, vomiting, loss of working capacity. It is necessary to examine the patient for the presence of a concussion or other damage to the brain, skull.

Also, with internal bruises, dizziness, loss of consciousness, decreased blood pressure twitching small and large groups muscles.

If a child develops a bruise two to three hours after he has hit, hemophilia should be suspected and a test for clotting factors should be done.

Severity classification

Depending on the size of the damage and the condition of the patient, subcutaneous hematoma has four degrees of severity.

• First degree. Hematoma after a bruise or minor injury. Weak hemorrhage of small sizes. The pain is insignificant, the temperature rises only locally. Light blue or red color. It goes away without treatment after a few days.
• Second degree. Bleeding is more severe, the area of ​​damage increases. Temperature rises locally. It hurts and burns slightly at rest. The color is blue or dark purple. Without treatment, it disappears in ten to fifteen days.
• Third degree. Large size and very intense pain, loss of function of nearby muscles. Rise in body temperature to subfebrile figures. As a rule, it occurs when the vessels of medium diameter are damaged.
• Fourth degree. Severe condition, severe damage to the skin and underlying structures, very severe pain, high fever. Such damage is most often accompanied by the addition of a secondary infection.

There is also a classification according to the lumen of the vessel. The hematoma can be pulsating and not pulsating. There may be blood clots, blood, pus, or infected blood inside. It is important to prevent infection of the content.

Therapy Methods

Hematoma removal conservative methods takes a long time. The body needs a significant amount of energy and resources to break down own blood at the site of the hemorrhage. Also read -.

Subcutaneous hematomas without complications should be treated immediately. The first thing to do is to apply cold immediately after the injury. Due to the cold, the vessel narrows, the bleeding stops, the area of ​​the bruise does not increase. The cold should be kept for about 20 minutes, after which a ten-minute pause should be made. You can apply a pressure bandage in the area of ​​manifestation.

Non-steroidal anti-inflammatory drugs are used to relieve pain. Aspirin should not be taken as it thins the blood.

After a hematoma has formed from a blow, special heparin ointments or bodyagu ointment can be smeared for treatment. Such funds will speed up the resorption process. Indications for surgical removal of a hematoma:

• big sizes;
• strong compression of tissues, muscles;
• suppuration;
• hematomas of internal organs that are not amenable to conservative treatment.

The operation is carried out immediately if the hematoma threatens the patient's life, for example, the brain or its parts are compressed, the large arteries are compressed.

You can not open bruises on your own, this can lead to infection, continued bleeding.

Folk methods

Each of us knows several popular ways to get rid of a hematoma. If the hematoma does not resolve for a long time, you can speed up this process with the help of traditional medicine.

Treatment at home can be carried out using a leaf of white cabbage.
You need to take a sheet, make notches and attach it to the bruise overnight. Notches are needed in order for the juice to come out better.

To remove an ugly blue stain, you can use lotions from salt. To do this, melt 150 grams of salt in hot water and moisten a bandage in it, then apply a bandage for 12 hours.

The onion mixture helps a lot. Grind the onion and add 3 tablespoons of salt to it, mix. Apply 2 times a day to the bruise. The duration of treatment is up to 5 days.

A mixture of honey and aloe in a ratio of 1: 1 is very popular. Apply 2 times a day.

A grated plantain leaf has a good effect. Apply the resulting slurry to the site of the hematoma. Also use lotions with castor oil.

All folk remedies are aimed at improving blood flow and accelerating metabolic processes, which stimulates faster resorption of blood clots.

Complications

Dangerous are hematomas near the nerves. Education can be on the face and neck, near the spinal cord and brain. Compression of a nerve or center in the cerebral cortex can lead to disability or death.

Also, this phenomenon can germinate with calcium salts or fibrous fibers and permanently leave a bulge. One of the most common complications is infection. Blood is a good medium for the growth of microorganisms. Only a surgeon should treat an infected hematoma.

A hematoma is a collection of blood escaping from a damaged vessel. In most cases, the skin over the bruise remains intact, although sometimes wounds and abrasions can be found on it.

Falling, bruising, excessive pressure, or hitting a blunt object; premenstrual period in women; reception medicines, which have an anti-coagulant effect (aspirin, etc.); hereditary and acquired disorders in the blood coagulation system * (for example, with hemophilia and other diseases).

Each of these factors can cause vessel damage and bruising. When several of them act together, the situation can become critical, which requires immediate medical intervention.

What is a hematoma? Hematoma changes on the body can occupy a small area, and can also spread widely, squeezing soft tissue structures with nearby internal organs. What causes bruises? When a person is hurt or hit, then, accordingly, he will have a hematoma after a bruise or a hematoma after a blow.

Sometimes soft tissue hematomas are formed due to the fact that a person has broken or dislocated an arm or leg, and another type of injury is also possible. What it is? Soft tissue hematomas are divided into subcutaneous hematomas and internal hematomas.

There are also multiple manifestations of hematomas, when red patchy formations are localized in one zone.

From the inside of the part of the body where there is damage, blood accumulates, then it thickens. At first, with a hematoma, there will be a predominance of red, then there will be more purple with a blue color. Later, depending on how the blood particles decompose, the formation will become yellowish with a green tint, or its appearance will be spotty with a predominant brown.

This formation will remind of itself on the affected area of ​​the body for a long period. What is a bruise?

Classification

G. are classified depending on the tissue or organ where they are located [subperiosteal; subserous; subdural; liver, kidney; intramuscular (tsvetn. fig. 5 and 6) and t / d], the state of the outflowing blood (coagulated G., infected and festering G.), the relationship to the lumen of the blood vessel (pulsating and non-pulsating G.).

ICD-10 code for superficial injury of unspecified localization - T14.0, code for obstetric pelvic hematoma - 071.7, intracerebral - 161.0-161.9

Differences between bruises and hematomas

It is important to know that injuries such as bruises are characterized by contusion of small capillary vessels located superficially, and hematoma changes are a complex injury that differs in its parameters.

If you touch the place where there is a hematoma process, then the person will instantly feel a sharp pain, and with a bruise, the pain will appear after pressing hard on it. Even the surrounding tissues can swell with a hematoma, and with a bruise, such changes are absent.

Also, if a bruise appears, then there is no hyperthermia, but this is observed during hematoma processes. Even muscle tissue will be mobile to a lesser extent with hematomas, provided that the blood has flowed into the muscle. With bruises, there are no such problems.

Causes of hematomas

The causes of hematomas most often include a traumatic effect on soft tissues - bruises, blows, pinching, squeezing, etc. The main mechanism for the formation of hematomas lies in ruptures of blood vessels. The size of the hematoma, the severity of its condition and the timing of treatment are directly dependent on the number of damaged vessels, their size and location.

In the same connection, experts divide hematomas into subcutaneous and formed on the internal organs. In the latter case, the degree of damage, potential danger for the patient's condition and the appointment of competent treatment of hematoma are determined exclusively in conditions medical hospital.

The need for mandatory treatment in a medical facility is due to the fact that the accumulation of blood in the organs responsible for the functioning of the life-supporting systems of the body, for example, with a brain hematoma, can lead to complete disability of the patient or even death in a short time.

Predisposing factors for different kind hematomas are somewhat different from each other, but the main cause of hemorrhages is considered closed injuries various parts of the body. Post-traumatic hematomas appear after a blow, bruise, fall, pinching or other traumatic factors.

There are also:

• Hematoma formation, localized paraorbitally. This subcutaneous type of outpouring of blood is manifested in the eye zone. This is a complicated formation with damage to the periorbital subcutaneous fat located in the orbital region and surrounding the eye. Complicated conditions of such an injury are manifested by a violation of cerebral hemodynamics with a swollen and swollen brain. The intracranial type of pressure will also increase, brain structures may shift, metabolism and brain function will be disturbed, and hypoxic changes will appear. There will also be problems with respiratory function and circulation.
• Intermuscular type of hematoma changes. Blood will accumulate between the muscle areas. This formation spreads over the space between the muscles due to its massiveness. It can dissolve on its own and disappear through certain period. If there is no resorption, then a connective tissue scar will appear, join infectious process, possible internal hemorrhages localized retroperitoneally, the development of peritonitis.
• Intense type of hematoma formation. Localized in the femoral and gluteal zone. Sick in this case specialist help is needed.

Clinical picture of different types of hematomas

The clinical picture is defined by hl. arr.

localization and size G. When G.

in hypodermic cellulose or in muscles - pains, dysfunction of the corresponding muscles, existence of the limited swelling, at a palpation a cut comes to light fluctuation (fluctuation). With a superficial location of G.

As with a hemorrhage, the soaking of tissues with outflowing blood and a gradual change in hemoglobin cause a characteristic change in skin color, depending on the period of G.'s formation, from lilac-red to yellow-green.

During the resorption of large aseptic G., an increase in body temperature is often observed, therefore, for the differentiation of G.

with an abscess may be required diagnostic puncture.
.

Pulsating G. is characterized by a pulsation of swelling felt on palpation, blowing systolic murmur when listening, as well as symptoms of limb ischemia (see Aneurysm, traumatic). Large G. may be accompanied by symptoms of acute anemia (see Blood loss).

Symptoms depend on the size of the hemorrhage and its location. Hematomas of the muscle and subcutaneous tissue are characterized by the following manifestations:

Swelling at the site of injury with the addition of edema of surrounding tissues; painful sensations, the intensity of which depends on the strength of the injury and location; a change in skin color: first, a bluish tint appears, indicating the accumulation of fresh blood, then, as it coagulates and dissolves, the color changes to reddish-purple, and then to yellow-green.

Local temperature increase in the bruised area; restriction of movement in the hematoma area due to impaired muscle function.

Even minor blows or injuries to the chest end in the formation of a hematoma of the mammary gland. If the blood tumor is of considerable size, then some of its cells may not resolve, degenerating into connective tissue.

If a hemorrhage occurred in the wall of an internal organ, then signs of compression of the latter and a violation of its functioning come to the fore. A large retroperitoneal hematoma often stimulates bleeding into the peritoneal cavity, causing peritonitis. The subserous form is much more dangerous than the subcutaneous one. The accumulation of blood near the lung leads to a violation of its function, clinically manifested by shortness of breath, cough, pain in the area of ​​the blood cavity. Complications can be considered incomplete resorption of the hematoma, followed by the formation of a scar from the connective tissue, infection, internal retroperitoneal bleeding, abscess, peritonitis.

Retrochorial hematoma can lead to termination of pregnancy, and hemorrhages in the brain can lead to consequences even after a successful surgical intervention.

Diagnosis of hematomas

For superficial hemorrhages, special diagnostic measures are not required, the diagnosis is established after examination, palpation and anamnesis. Other forms require more research. With a subserous hematoma, for example, of the lungs, X-ray diagnostics will be needed.

To determine the size, the exact localization of the hematoma of the internal organ, it is necessary to conduct an ultrasound examination (ultrasound). If the results obtained are not enough, then appoint a magnetic resonance or computed tomography. One of them in without fail do with hemorrhages in any part of the brain.

In addition to MRI and CT, the diagnosis of intracranial hematomas includes an x-ray of the skull in two projections and encephalography. AT doubtful cases shown lumbar puncture followed by a study of liquor - cerebrospinal fluid.

Treatment of hematomas

At superficial G. in most cases treatment conservative. AT early period- hemostatic therapy (see Bleeding), rest, cold, pressure bandage. After the cessation of bleeding, agents that accelerate resorption are used - heat, physiotherapy, massage, to lay down. gymnastics, etc. At big G. the puncture with removal of liquid blood and the subsequent imposing of a pressure bandage is shown. If it is not possible to aspirate blood during puncture (coagulated G.), a small incision can be made, blood clots removed, and after administration of antibiotics, the wound can be sutured.
emergency operation it is shown at epi - and subdural G. with a prelum of a brain. In these cases, a trepanation of the skull is performed, G. is removed and the bleeding is stopped. With pulsating G., after specifying the nature of the damage to the artery (angiography), it is ligated, a vascular suture is applied, or plastic surgery is performed on the artery, and the timing of surgical intervention is determined by the degree of violation of the peripheral circulation.

G.'s opening of any localization is shown at its suppuration. In these cases, surgery and subsequent treatment are carried out according to the general principles of treatment of acute surgical infection(see Abscess, Phlegmon).

Forecast. Small G. completely resolve, with large G. partial resorption is combined with reactive inflammation and subsequent germination. connective tissue with the formation of a scar, sometimes petrified. Infection and suppuration of G. is possible. A more rare outcome of G. is encapsulation with the formation of a false cyst (see).

A. V. Grigoryan, S. V. Lokhvitsky.

The need and choice of tactics for the treatment of hematomas is determined by specialists and primarily depends on their variety. But if you are absolutely sure that the resulting hematoma is superficial, and you can cope with its treatment on your own, then you can recommend using the following means from hematomas.

The method of treatment depends on the location of the hematoma, its type and size. Small subcutaneous hemorrhages pass without assistance. Treatment of the underlying disease will help get rid of pinpoint hematomas, which are its manifestation.

Subcutaneous and intramuscular bruises can be removed by yourself. First aid for bruises- applying ice for no more than 10 minutes. This will help narrow the blood vessels, prevent swelling and reduce the amount of blood flowing out. If the blow fell on a limb, then a temporary tight bandage can be applied.

Treatment at home is already possible 1-2 days after the bruise. For this, heparin ointment or another, for example, with bodyaga or hirudin, is suitable. External application up to 3 times during the day will accelerate absorption.

A popular folk remedy for bruises is a bodyagi compress. To do this, mix 2 tbsp. spoons of powder from it with 4 tbsp. spoons of water.

Hemorrhages in internal organs, and especially in different shells brain require a mandatory visit to the doctor. In case of subarachnoid, intraventricular and other bleeding into the brain, urgent hospitalization is required in neurosurgery, where they will provide bed rest and choose the best treatment. Hematomas of small volume, not exceeding 40 ml, are treated conservatively. For large hematomas that compress areas of the brain, an operation is necessary - craniotomy. In such cases, with an internal hematoma of the organ, an urgent surgical intervention is also performed, in which a cavity with blood is opened, the latter is removed by aspiration.

An infected blood tumor is treated like all abscesses, a postoperative one is treated by partial removal of some sutures, separation of the edges of the wound, opening of the hematoma and removal of blood from it.

Whether special therapy is needed, what is its tactics - experts know all this. Methods for treating hematoma are associated with its specific variety. A person must be absolutely sure that his hematoma is superficial. Then he can fix it on his own. Recommended simple, but effective methods.

A cold compress is applied as quickly as possible to the hematomas of the facial part of the head. The most suitable lotion will be with ice. The low temperature will cause the blood vessels to constrict rapidly. The hematoma will stop growing.

Treatment of a hematoma depends primarily on its type, severity and distribution. With subcutaneous and intramuscular damage, you can independently implement some measures that will quickly eliminate the symptoms. An excellent remedy for a hematoma is the usual cold compress, but it must be applied immediately after the impact. Ice, some frozen food from the freezer, or cold running water will do. Under the influence of low temperature, the vessels narrow sharply, which prevents an increase in the size of the swelling. After a few days, it is recommended to use such a hematoma remedy as a warm compress, which helps to absorb the outflow of blood. Ointments with badyaga, hirudin, medicines with a resolving effect for external use, as well as applications with clay have a beneficial effect.

If the clot has not resolved sufficiently, suppuration forms at the site of damage. This phenomenon is typical for those cases when the patient did not take appropriate measures in time. At the first signs of suppuration, you should definitely consult a doctor.

With inefficiency conservative means with a hematoma, the skin in the area of ​​​​damage is pierced and removed liquid part blood. If the bleeding lasts for a long time, then ligation of the bleeding vessel is required. Suppuration of a hematoma also involves opening a skin area and applying drainage.

For cerebral hematoma conservative treatment, but it is also important to maintain normal intracranial pressure with barbiturates, hyperventilation of the lungs and some other measures. If the patient's condition worsens, surgery is required.

Surgical intervention is indicated for epidural hematoma, which is extremely dangerous for the patient.

Symptoms of a hematoma appear from the period as soon as the injury occurred. At the beginning, the skin becomes sharply painful. With a hematoma, the symptoms are characterized by the fact that instantly the painful area becomes edematous. This swelling spreads and makes it difficult to move.

After the appearance of edema, the area with hemorrhage quickly becomes reddish. Signs of a hematoma are manifested by the fact that the patient feels internal tension and hardening in the area where hematoma changes have appeared. Their color can be different: red or purple, but often there is no clear color.

For example, the border of a hematoma formation can be blue, dark, and inside there will be a red tint.

How to remove a hematoma? What is the treatment for bruises and bruises? As a rule, treatment measures depend on the severity pathological process.

If the formation is superficial, then independent medical measures allowed. With internal hematoma formations, surgical intervention is necessary. How to dissolve a hematoma?

On the front or head zone with a superficially formed hematoma change, it is urgent to make and apply a cold type of compress to the damaged area. This is of great importance, since the effect of ice can instantly narrow the vascular tissue, so the hematoma does not grow. This will prevent edematous changes.

How to treat a hematoma? If a hematoma has formed on lower limb, then for a hematoma, the treatment will be the imposition of a tight bandage on the site of damage. It is necessary to monitor the patient's well-being, to observe temperature indicator body, because with such a bruise, the resorption of blood clots will be slow, which will lead to suppuration.

How can you get rid of a hematoma? If a person does not have problems with blood circulation, then the resorption of such blood clots will be good, and the use of absorbable ointment and analgesics will also help to cure these formations. Hematoma treatment will be successful with the use of physiotherapy procedures that will help remove edematous changes. If the edemas occupy a large area, then it is necessary to suck out liquid blood.

If an intracranial type of hematoma formation is suspected, then the treatment of the hematoma should be in a hospital, where diagnostics will be carried out with assistance to the patient. With an intracranial hematoma from a blow, the treatment consists in an urgent surgical intervention, in which the skull is trepanned and removed blood clots. The operation is complicated, then a long one is needed postoperative period.

We treat bruises at home

Why do bruises appear? Injuries in the form of a bruise and frequent complicated conditions, manifested by bruises and hematomas, in simple cases amenable to correction folk methods treatment.

Treatment of a bruise at home will not require a long time period and will save a person from complicated conditions. How to cure a bruise? To quickly remove bruises will help certain recommendations. First you need to provide a minimum motor activity for the part of the body that is damaged.

Bandaging with an elastic bandage will help remove the bruise. How to remove a bruise? Only cold exposure in the form of snow, ice water or a cold object will help to remove a bruise on an injured area of ​​\u200b\u200bthe body.

A cold type of compress will help to remove the bruise, which can be done thanks to a product that is in a frozen state or a heating pad, in which there should be ice water. Treatment of bruises in this way will bring a positive effect a day after the injury.

Thanks to this cold, a bruise can be removed, since it has a vasoconstrictive effect, fights bruising in the tissues.

Cold instantly removes edematous phenomena, preventing subsequent destructive states of tissue structures. How to remove a bruise? Applying cold exposure is required in the right way.

To prevent destructive cold effects on the skin, a cold object is wrapped with a natural cloth. Cold exposure should not be more than 15 minutes, so as not to freeze or overcool soft tissue structures. After 2-3 hours, these manipulations are repeated, only they will help remove the bruise.

How to treat bruises? In order for this type of injury to pass, the injured part of the body (arm, leg, finger) is lifted up, which will prevent the development of edematous changes and improve blood flow. Before going to bed, the iodine mesh cleans the bruise well, which fights local inflammatory processes, while also having a regenerative effect.

How to get rid of a bruise? In order for the bruise to pass as quickly as possible, it is necessary in a day, as soon as the edematous changes have disappeared, to apply heat to the injured area of ​​the body. A little salt is heated in a frying pan, poured into a small cloth bag or a simple sock and applied to the damaged area for a quarter of an hour. Such warming is done 2 times a day.

About ointments

How to remove a bruise and swelling? Various ointments and creams that relieve inflammation, swelling and soreness enhance absorbable processes, restoring damaged capillary vessels. How to deal with bruises? The ointment, which includes heparin, is well removed from bruises, troxevasin gel is also used. These funds normalize venous blood flow, relieve hematoma processes.

Thanks to the troxerutin component, which is included in troxevasin ointment, vascular walls, and the heparin component in a similar ointment will dissolve the blood in a clotted state so that the bruise passes quickly.

With the help of lyoton gel, bruises will also resolve, edematous changes will decrease. The drug has a disinfecting effect, it is applied even to an open wound. This gel remedy will prevent skin defects in the form of scars, accelerate the regeneration processes on the skin, which is very important for the treatment of hematoma formations on the facial area and open areas of the body.

The Rescuer balm, which includes fir oil, mountain ash, calendula extracts, has a very good wound healing effect. Regeneration of wounds, resorption of bruises will be quick, compared with other similar means.

It is worth remembering that if the injury is serious, the patient will only be helped medical assistance often in the form of surgery. In this case, delay is a danger to human life.