Severe bruise. Providing primary care for bruises and hematomas at home - an algorithm of actions and treatment. Possible consequences after bruises

The upper extremities are susceptible to injury. One of the most typical injuries is a bruise of the arm in the area between the elbow joint and the hand. Anatomically, this area is called the forearm. Despite the apparent simplicity of the injury and the ease of progression of the bruise, the painful condition can limit a person’s quality of life for several weeks. Moreover, the consequences of some injuries can persist for a long period, leading to serious impairment of limb function.

Shulepin Ivan Vladimirovich, traumatologist-orthopedist, highest qualification category

Total work experience over 25 years. In 1994 he graduated from the Moscow Institute of Medical and Social Rehabilitation, in 1997 he completed a residency in the specialty “Traumatology and Orthopedics” at the Central Research Institute of Traumatology and Orthopedics named after. N.N. Prifova.

The painful condition is a traumatic injury to all tissues of the forearm without destruction of bone structures. Usually the muscles, subcutaneous tissue, as well as the vessels and nerves located in this area are affected. The main cause of hand bruises is trauma due to direct strong contact of this part of the body with a hard surface.

Most often the problem occurs in the following situations:

• when falling on your hand;
• if a knuckle is injured during sparring between athletes or in a street fight;
• when hitting a hard surface;
• during careless handling of equipment in dacha conditions;
• as a result of compression by two hard objects.

Since hands are an integral part of a person’s active life, they are especially often injured during everyday or sports activities. Hand bruises occur regularly in the following population groups:

• children;
• summer residents and gardeners;
• mechanics and carpenters;
• athletes;
• aged people;
• car enthusiasts.

The mechanism of injury is always the same - as a result of strong contact with a hard surface, the soft tissues of the forearm are damaged. This leads to rupture of small capillaries, destruction of nerve fibers, and muscle damage. As a result of violation of the integrity of the vascular wall, local hematomas are formed, and edema forms and increases in the area of ​​injury.

The main manifestations of hand bruises

The problem is always a consequence of an acute injury, so all symptoms develop immediately after injury and then progress. The forearm is anatomically characterized by a small layer of subcutaneous fat, so with bruises there is a high probability of damage to nerve trunks and vascular lines. In the same area are the bone structures of the wrist joint and small joints of the hand.

Clinical manifestations of bruise are as follows:

• severe pain in the damaged area, which radiates to the shoulder, hand, or even to the armpit;
• swelling of the tissues of the forearm;
• skin hyperemia, which then turns into long-lasting cyanosis;
• limb dysfunction;
• inability to work with a brush;
• numbness and paresthesia of the distal parts of the upper limb.

The bruise can involve the bones of the wrist, elbow, as well as neighboring parts of the limb - the shoulder or phalanges of the fingers. In this case, there is a sharp limitation in the function of the hand, it goes numb, since the painful condition is accompanied by damage to the nerve structures over a large area.

The main symptom that forces the patient to seek medical help is pain. Its strength is initially caused directly by a strong blow, and then persists due to the formation of a hematoma.

Any damage to the radius increases pain, but there are no visible fractures with bruises. The swelling of the arm, due to massive swelling caused by impaired circulation and lymphatic drainage, remains for several days.

As the function of the arm is restored, the pain first disappears, then the swelling, and only after that the normal color of the skin appears. However, bruises can persist for a very long time, since their resorption strongly depends on the individual characteristics of blood counts and the strength of the traumatic impact.

There are three degrees of severity of a hand injury. Their main differences are discussed below.

• Slight bruise. The injury is limited to a small area. Bone structures and great vessels are not damaged. All clinical manifestations disappear within 2 weeks.
• Moderate bruise. Swelling and pain are pronounced. There is a hematoma, which is characterized by a persistent course. Individual areas of soft tissue crushing. Bone structures are intact. Convalescence occurs within a month.
• Severe bruise. Signs of soft tissue crushing and damage to periosteal structures. Sharp pain, prolonged swelling, damage to nerve trunks and great vessels. Complications often arise that require surgical treatment. Convalescence is long, symptoms of general intoxication last up to a week, and recovery takes up to 3 months.

A severe bruise cannot be cured quickly, since neurological disorders often persist for a long time (the hand goes numb) and the function of the limb decreases.

A long-lasting hematoma has a high risk of infection, which is dangerous due to the development of phlegmonous inflammation. As a result, ossification sometimes occurs, making the muscles hard, less functional, and requiring surgery.

One of the types of pathology of the distal parts of the hand is a bruised fist. It occurs due to direct contact of a limb in a compressed state with a solid object. As a result, a sharply painful lump forms on the back of the hand below the wrist joint. This bump lasts a long time after an impact, as it is a consequence of crushing soft tissues and resulting local swelling. As a result, ossifications form at this site, which are removed surgically.

How to distinguish the manifestations of a hand bruise from a fracture

The first question facing a person who has been injured is to rule out a fracture. The table below discusses the main distinctive features of these pathological processes.

It is often impossible to accurately determine whether a fracture is present based on clinical data alone. Due to the individual sensitivity of the body, pain can be very difficult to bear, and tissue compaction after a bruise can simulate a fracture. Therefore, it is imperative to contact the emergency room as soon as possible for a full diagnosis of the problem.

Diagnosis of hand bruises

In most cases, the bruise is not life-threatening for the patient. However, during the diagnostic process, it is important to distinguish it from other serious injuries - fractures, sprains or ruptures of muscles and tendons. Therefore, in addition to a clinical examination and studying the details of the injury, an instrumental examination is indicated. The main stages of the diagnostic search are discussed below.

• X-ray of the forearm. Helps the doctor understand whether there is a bruise or fracture of a limb, since bone structures are clearly visible during the examination.
• Ultrasound. The method provides diagnostics of the condition of soft tissues - the presence of hematomas, muscle or tendon ruptures.
• CT scan. If, during an X-ray examination, questions remain regarding problems with bone structures, then they should be examined layer by layer. This is ensured through CT scanning of the forearm.
• MRI. This precise method is rarely used, but it is indispensable in diagnosing processes occurring in soft tissues. MRI helps to understand whether there is a bruise or muscle strain, small tendon ruptures and hidden hematomas.

Additionally, blood tests are used to assess hemoglobin levels and acute phase parameters. The entire diagnostic search is carried out within a short time, as it is necessary to assess the severity of the injury.

Emergency care: general principles of treatment for a bruised hand

Since the body’s reaction to an injury develops especially strongly in a matter of minutes, it is necessary to quickly provide qualified first aid. It includes the following points:

• free your hand from clothes;
• apply cold - if it is ice, then not on the skin, but through a towel or bandage;
• ensure immobilization, since visually distinguishing signs of a bruise from a fracture is very problematic;
• give an anesthetic - diagnosis in a medical institution is not based on the patient’s subjective feelings, so taking analgesics is justified;
• transported to the hospital for examination by a doctor and x-rays.

To ensure cold, it is better to use compresses with water, periodically changing the bandage.

Traditional treatment for a bruised hand at home

Typically, a hand bruise requires treatment at home, since only patients with suspected serious injury or when it is impossible to exclude damage to the great vessels are hospitalized. General treatment principles include:

• taking analgesics, often from the NSAID group (diclofenac, naproxen, nimesulide);
• elastic bandage to improve hematoma resorption;
• external therapy to relieve the tumor - anticoagulants and reparants (heparin, dexpanthenol);
• in the presence of damage to the nervous system - vitamins and antispastic agents;
• in the presence of a pronounced emotional reaction of the patient, sedatives are used.

If a child’s arm is swollen and hurts, then it is necessary to restore its activity as soon as possible. Compresses with cold saline solution, external gels for resorption of hematomas and analgesics from the paracetamol group will help. If they are not very effective, then only ibuprofen can be used among non-steroidal anti-inflammatory drugs.

The principles of treatment for hand bruises caused by a fall or after a strong blow are practically the same. The most important condition for a speedy recovery is the use of cold in the first minutes after injury. This will limit the size of the hematoma, which will allow for rapid treatment and restoration of activity of the upper limb.

Recovery after a hand injury and possible consequences

The problem does not apply to severe injuries, so convalescence occurs within 10-14 days. Bruises resolve, as rehabilitation progresses, they become yellowish, and then only a hyperpigmented area on the skin remains.

However, as a result of the bruise, long-term consequences may persist. These include:

• hematoma suppuration;
• compression of the midline structures of the arm, which leads to impaired blood circulation and innervation of the limb;
• muscle ossification - painful compaction in soft tissues that makes active movements difficult;
• damage to nerves and blood vessels.

The consequences of a hand injury often occur after a fall, since the mechanism of injury is associated with the impact of body weight on the upper limb. All complications are curable, but rehabilitation sometimes increases to 6 months. The therapy process includes drugs that increase blood flow to the limb, as well as improve the trophism of nervous tissue (peripheral vasodilators, muscle relaxants and vitamins). Sometimes surgical treatment is necessary to eliminate ossified areas.

Conclusion

Thus, a hand bruise is a painful injury that can deprive a person of his ability to work for a long time. The consequences of damage to the forearm can remain for many years, affecting the function of the limb. Muscle ossification is especially dangerous, leading to the appearance of rough, painful lumps at the site of injury. In the absence of complications, a hand bruise disappears within 2 weeks, and severe cases last up to 3 months. The sooner the patient receives qualified assistance, the faster the favorable outcome of the injury will occur. In most cases, conservative treatment gives a positive result and provides a good prognosis for a speedy recovery.

If the pain in your arm does not go away - doctor's advice

Brain contusion is damage to brain structures that occurs as a result of traumatic brain injury. With a bruise, areas of necrosis form in the brain ( tissue destruction) of various sizes. A characteristic feature of this brain damage is loss of consciousness. The duration of fainting is directly dependent on the degree of tissue trauma. Often a brain contusion is combined with a closed fracture of the cranial bones ( without damage to surface tissues).

In the structure of all traumatic brain injuries, brain contusion occurs in 20–25% of cases. It is customary to distinguish three degrees of severity of brain contusion - mild, moderate and severe. The severity depends on the nature and size of damage to brain structures. Most often, this pathology leads to damage to the frontal lobes of the brain.


Interesting Facts

• The first mention of brain contusion dates back to 3000–2500. BC. This information was contained in one of the Egyptian papyri.
• It is worth distinguishing between the concepts of brain contusion and concussion. The main distinguishing feature is that a concussion does not lead to significant damage to brain tissue.
• Alcohol intoxication is a concomitant factor in the occurrence of brain contusion.
• Brain contusion can lead to memory loss ( amnesia). The victim not only loses memories before receiving a traumatic brain injury ( retrograde amnesia), but is also unable to remember anything for some time after the injury ( anterograde amnesia).
• According to statistics, brain contusion is diagnosed, on average, 2–3 times more often among men than among women.
• In 45% of cases, a mild degree of brain contusion is diagnosed.

Causes of brain contusion

Alcohol intoxication is a concomitant factor influencing the incidence of brain contusion. According to statistics, when diagnosing a brain contusion, in 5–20% of cases the victim can be identified as being intoxicated to varying degrees. Alcohol intoxication leads to an increase in the number of cases of road traffic accidents, which is one of the main causes of brain contusion. It is also worth considering the fact that victims with a mild degree of brain contusion do not always seek medical help immediately after receiving a traumatic brain injury.

Brain contusion can result from the following types of injuries:

• domestic injuries;
• road traffic injuries;
• childhood injuries;
• criminal injuries;
• industrial injuries;
• sports injuries;
• injury sustained during an epileptic attack.

Domestic injuries

On average, 25% of household injuries occur due to falls from human height onto the floor or onto various objects. In this situation, falling onto a hard object can result in a traumatic brain injury and lead to a brain contusion.

Road traffic injuries

Throughout the year, road traffic injuries predominate in the winter season. This is due to unfavorable meteorological conditions - frequent ice, fog, precipitation in the form of wet snow. During the day, road traffic injuries are observed in most cases after lunch - in the afternoon. The reason is decreased concentration, talking on the phone while driving, drunk driving, etc.

In urban areas, road traffic injuries usually occur when a passenger car collides with a pedestrian. In rural areas, road accidents involving trucks predominate. It is worth noting that road traffic trauma combines various types of damage to all areas of the body, including the head. Brain contusion, in most cases, is a consequence of road traffic accidents.

Child injury

It is worth noting that many more children die from childhood injuries and accidents than from all infectious diseases. The frequency of injuries depends on the age group of children. So, for infants ( up to 1 year) the most common cause of brain contusion is falling out of the hands of parents, as well as falling from heights of changing tables and beds. Children 2–3 years old typically fall from slides, swings, stairs, door and window openings. At school age, road traffic injuries prevail. Often, traumatic brain injury among senior schoolchildren can be received as a result of a criminal injury, during a street fight, and so on.

Criminal injuries

Most often, a brain contusion occurs due to a blow to the head with a heavy blunt object ( stone, stick, bat, brass knuckles, hammer, etc.) or with a fist, as well as during a forced fall to the ground or onto a hard object with the head. Most cases of criminal trauma occur among people aged 19 to 25 years.

Industrial injuries

Victims of work-related injuries are most often inexperienced workers. Ignorance of the technological process, as well as untimely response to potentially dangerous situations, in most cases leads to work-related injury. Also, accompanying factors of industrial injuries may be insufficient lighting, defects in the operation of production equipment, faulty personal protective equipment ( hard hat, helmet and so on).

Sports injuries

According to statistics, traumatic brain injury among athletes occurs in 10–20% of cases in the structure of all injuries. There are particularly traumatic sports where the incidence of traumatic brain injuries is extremely high. These sports include boxing, martial arts, cycling, mountain slalom, handball, ski jumping, snowboarding and others.

Trauma sustained during an epileptic seizure

With a traumatic brain injury, a head contusion occurs as a result of certain biomechanical processes that occur during an impact. At the moment, the theory of impact-impact damage has become widespread.

In the mechanism of brain contusion, the following processes are distinguished:

• brain displacement;
• movement of the cerebral hemispheres;
• hydrodynamic effect on the brain;

Movement of the cerebral hemispheres
Between the zone of impact and counter-impact there remains a zone of the brain stem, which does not change its position. The brain stem consists of the medulla oblongata, midbrain and pons. The displacement of the cerebral hemispheres in relation to the medulla oblongata leads to damage in the reticular formation. This brain structure is responsible for consciousness. During an impact, the brainstem does not receive descending impulses from the cerebral cortex, and this leads to depression of consciousness up to its loss. There is a directly proportional relationship between the force of the blow and the time spent unconscious.

Hydrodynamic effect on the brain
At the moment of impact, the cerebrospinal fluid in the ventricles of the brain ( cavities filled with cerebrospinal fluid) moves with significant acceleration in a certain direction ( direction depends on impact). The consequence of this phenomenon is the formation of numerous so-called Dupree punctate hemorrhages. They almost always occur, regardless of the location of the impact. As a rule, they can be found in the 3rd and 4th ventricles of the brain.

Signs and symptoms of brain contusion

Mild brain contusion

The following symptoms are typical for a mild brain contusion:

• Loss of consciousness is a characteristic symptom of brain contusion and occurs in 100% of cases. When a traumatic brain injury occurs, the cerebral cortex is for some time unable to transmit nerve impulses to the brain stem, where a special structure is located - the reticular formation, which is responsible for maintaining consciousness. In the absence of activity in the reticular formation, loss of consciousness occurs until the cerebral cortex again restores interaction with the brain stem. Loss of consciousness due to a brain injury can last from 2 – 3 minutes to an hour.

• General state of consciousness. With a mild injury, consciousness is defined as moderate stun. The victim is slightly inaccurately oriented in space and time. There is lethargy and drowsiness.

• Traumatic amnesia. Memory loss is observed in the vast majority of cases of brain contusion. Amnesia can be of three types - retrograde, anterograde and mixed. With retrograde amnesia, the victim forgets the events that preceded the traumatic brain injury. Anterograde amnesia is characterized by the inability to remember anything after injury. In the case of mixed memory loss, the victim for some time cannot remember objects or phenomena that surround him. The process of memorization is extremely complex, and it involves the parietal, occipital, temporal lobes, hippocampus and other brain structures. Memory loss occurs as a consequence of pathological disorders in these segments. It is worth noting that traumatic amnesia is temporary. The period of memory recovery depends on the severity of damage to brain structures.

• Headache or cephalalgia may occur due to various mechanisms. In the first time after injury, headache occurs due to liquorodynamic disturbances. This mechanism occurs due to changes in the position of brain structures ( cerebral hemispheres) in the cranial cavity, as well as with an increase. At the next stage, the cause of the headache is local swelling of the brain, which occurs in the area of ​​impact and counter-impact. Edema is a consequence of the inflammatory process at the site of primary damage to the brain structures. Pain receptors contained in the vessels of the skull are compressed by this swelling, which leads to severe headaches. The duration of the headache depends on the degree of damage to brain tissue. In most cases, with a mild brain contusion, the headache can last for 2 to 3 days, and then gradually fade away.

• Dizziness may appear due to damage to the structures of the cerebellum if the blow was to the back of the head. Also, the cerebellum can be injured if it is in the impact zone. This is often due to impaired blood supply. Damage to the cerebellum leads to an inability to maintain body position and loss of stability. It is also necessary to distinguish between the concepts of dizziness and fainting. The first is not characterized by muscle weakness in the upper and lower extremities, decreased blood pressure, decreased auditory and visual perception ( darkens in the eyes and rings in the ears).

• Vomit. Vomiting with a mild brain contusion most often appears once. It is worth noting that vomiting does not bring relief, since it is cerebral ( brain) origin and is not associated with gastrointestinal pathology. With traumatic brain injury, transient disorders occur in the brain stem. It is there, in the bulbar zone, that the vomiting center is located. It is worth noting that with a brain injury, the feeling of nausea does not occur, and vomiting appears suddenly, being spontaneous.

• Heart rhythm disturbance. Heart rhythm disturbances are quite common in cases of brain contusion. As a rule, there is an unpronounced increase or decrease in the number of heartbeats ( more than 90 or less than 60 contractions per minute), as well as an increase in blood pressure to 140 - 150 mm Hg. Art. These processes arise due to disorders in the autonomic nervous system ( system that regulates the functioning of internal organs). During a traumatic brain injury, a redistribution occurs in the innervation of organs, including the heart. The heart is innervated by the sympathetic and parasympathetic nervous systems, which are part of the autonomic nervous system. With a brain injury, depression of one nervous system and excessive activation of another occurs. If the heart is predominantly affected by the sympathetic nervous system, this leads to tachycardia ( increased heart rate that exceeds 90 per minute) and increase blood pressure. Quite rarely, with a mild brain contusion, the opposite picture can be observed when the heart is innervated by the parasympathetic nervous system. In this case, the number of heart contractions will be reduced, and the pressure in the arterial vessels will decrease.

• With a traumatic brain injury, external respiration disorders may occur. The respiratory center is located in the brain stem, in the medulla oblongata. Transient disturbances that occur in this area of ​​the brain can lead to tachypnea ( increased breathing). With a mild brain injury, mild disturbances in external respiration are observed, which may disappear within a few days.

• Temperature reaction. In some cases, body temperature may be slightly elevated, but within 36.9 °C.

• Neurological symptoms. With a brain contusion, the most common neurological symptom is clonic nystagmus ( involuntary movements of the eyeballs). A mild degree of anisocoria is also observed. Anisocoria is characterized by the fact that the victim has different pupil sizes in the right and left eyes. This occurs due to damage to structures in the oculomotor nerve. Brain contusion is also characterized by meningeal lesion syndrome ( The meninges cover the surface of the brain on top and, depending on the type, perform different functions). At the time of traumatic brain injury, the integrity of the soft and arachnoid membrane of the brain is disrupted, which leads to the appearance of symptoms similar to meningitis. Among the meningeal symptoms, one can note the symptom of stiff neck muscles ( increased tone of the neck muscles), Kernig's sign ( If in a horizontal position you bend your knee at an angle of 90 degrees and bring it towards you, then it will be impossible to fully straighten the knee joint). Also in the context of meningeal symptoms, one can often find the upper Brudzinski sign ( if you try to bring your chin to your chest, the knee joint will reflexively flex). This symptomatology persists for 2–3 weeks and, ultimately, gradually regresses ( disappears).

Moderate brain contusion

The following symptoms are typical for a moderate brain contusion:

• Loss of consciousness. In the case of a more serious brain injury, loss of consciousness can last from 10 minutes to 5 to 6 hours. With a moderate brain contusion, the cerebral cortex cannot actively interact with the reticular formation for a long period, which leads to an unconscious state. In this condition, involuntary urination and defecation are often observed.

• General state of consciousness. In most cases there is deep stunning. This condition is characterized by deep lethargy. The question usually does not follow a detailed answer, but only monosyllabic phrases “yes” and “no”. There is a lack of orientation in time and space. The victim is only able to perform simple tasks.

• Traumatic amnesia is of a pronounced nature. For several hours, and sometimes even several days, the victim is unable to reproduce the events that preceded the injury, as well as the events that happened to him after the injury. Traumatic amnesia is temporary and the victim regains memory within a few days.

• Headache or cephalalgia. Moderate brain contusion is characterized by severe and severe headache. When the bones of the skull are fractured, the soft membrane of the brain ruptures. This membrane contains vessels that supply blood to the brain. The wall of each blood vessel contains pain receptors, and if they are injured, a severe headache occurs. Also, headaches occur when the integrity of the dura mater, where the largest number of pain receptors in the entire human body is located, is disrupted.

• Vomit may appear multiple times. The gag reflex is a consequence of transient disorders in the vomiting center, and can also appear in case of increased intracranial pressure. Vomiting does not bring a feeling of relief. Nausea with brain contusion does not precede vomiting.

• Heart rhythm disturbance. With severe traumatic brain injury, heart rhythm disturbances often occur. These disorders occur due to transient disorders in the autonomic nervous system. If the work of the heart is regulated by the sympathetic nervous system, this leads to tachycardia and arterial hypertension. When the heart receives innervation primarily from the parasympathetic nervous system, this leads to bradycardia.

• Respiratory rhythm disturbance. With a brain injury, the breathing process also undergoes a pathological change. Most often, tachypnea is observed without pronounced changes in the patency of the lower respiratory tract ( trachea, bronchi). Tachypnea is caused by transient disturbances in the respiratory center.

• Temperature reaction. A moderate brain contusion is characterized by subfebrile body temperature ( within 37 – 37.5°C). Low-grade fever occurs due to temporary disturbances in the hypothalamus. The hypothalamus is the highest regulator of body temperature. In case of injury, the nuclei of the posterior hypothalamus, which are responsible for increasing the temperature, dominate over the nuclei of the anterior part, which contribute to a decrease in body temperature.

• Neurological symptoms with moderate brain contusion they are more pronounced. Not only nystagmus and anisocoria are observed, but also disturbances in oculomotor function. Cellular damage in some segments of the brain leads to partial loss of motor sensitivity. This inevitably leads to the appearance of paresis of the upper and lower extremities. Loss of motor sensitivity is often observed in some areas of the body. Moderate brain contusion is also characterized by the appearance of meningeal symptoms ( Kernig's sign, Brudzinski's sign and neck stiffness sign). It is worth noting that these neurological symptoms are observed for 4–6 weeks and after that gradually regress.

Severe brain contusion

The following symptoms are typical for a severe brain contusion:

• Loss of consciousness. Unconsciousness with a severe brain contusion can last from several hours to several weeks. Inflammatory and destructive processes in the brain are so serious that the reticular formation is unable to perform its functions of maintaining consciousness for a very long time.

• General state of consciousness. After receiving a traumatic brain injury, as a rule, a deep comatose state is observed, after which the general state of consciousness changes to soporous. The following manifestations are characteristic of a deep coma: the victim cannot be awakened, the eyes do not open to pain, the act of swallowing is difficult, there is no control over the sphincters ( manifests itself in the form of involuntary urination and defecation), serious disturbances in heart rhythm and respiratory rhythm. When recovering from a coma, a soporous state can be detected in the victim. Stupor is characterized by the following symptoms: pathological drowsiness, sometimes the victim opens his eyes to the influence of strong irritants ( pain, loud sound), the functions of the cardiovascular and respiratory systems are preserved, sphincter control is not observed.

• Heart rhythm disturbance. Increasing pathological changes in the functioning of the cardiovascular system directly threaten life. Abnormalities in heart rhythm can lead to severe tachycardia or bradycardia ( above 150 or below 60 beats per minute). Arterial hypertension is also observed, in which the pressure rises above 160 - 180 mm Hg. Art. These disorders are a consequence of damage to the cardiovascular center in the medulla oblongata.

• Respiratory rhythm disturbance. In severe traumatic brain injury, destructive and inflammatory changes also affect the respiratory center, which is located in the brain stem. This leads to severe disturbances in external respiration, and can also lead to obstructive asphyxia ( airway obstruction) due to obstruction of the upper respiratory tract. In some cases, Cheyne-Stokes or Biot respiration is observed. Pathological Cheyne-Stokes breathing is characterized by alternating deep and shallow breathing, as well as periods of apnea ( prolonged absence of breathing). With pathological breathing Biot, normal rhythmic breathing is observed, followed by periods of apnea, which last more than 30 seconds. These respiratory rhythm disturbances indicate the severity of the inflammatory-destructive process in the brain and have an unfavorable prognosis.

• Temperature reaction. Changes in body temperature occur as a result of the effect of cerebral edema on the hypothalamus, which is the highest center of thermoregulation. When the hypothalamus is irritated, reflex activation of the posterior nuclei occurs, which leads to hyperthermia ( elevated body temperature). Hyperthermia is characterized by an increase in temperature above 39°C. This temperature can be higher - up to 40 - 41°C and pose a threat to the life of the victim. Such a high temperature disrupts the water-salt balance of the body, leading to disruption of the delivery of nutrients and oxygen to tissues, including the brain, which is a pathological vicious circle. Sometimes, with hyperthermia, convulsions are observed.

• Neurological symptoms. With a severe brain injury, the following signs may appear: bilateral narrowing or dilatation of the pupils ( miosis or mydriasis), multiple tonic nystagmus ( involuntary movements of the eyeballs with a long slow phase). The symptoms also include severe damage to motor and tactile sensitivity, which leads to paresis and paralysis of the limbs. Muscle tone is usually impaired, as well as tendon reflexes, reflexes of the skin and mucous membranes. In some cases, severe brain contusion can lead to local or generalized seizures.

How is a brain contusion diagnosed?

The diagnosis is made by assessing the following criteria:

• general state of consciousness;
• condition of vital organs;
• neurological disorders.

General state of consciousness

The following types of general state of consciousness are distinguished:

• Clear consciousness characterized by an adequate perception of surrounding people, phenomena and one’s own “I”. Correct orientation in time and space is observed. Mental functions do not undergo changes.
• Stun is moderate. In this condition, drowsiness is observed. When orienting in space and time, small inaccuracies arise. Response to verbal commands is slightly slower. There is a normal motor reaction to a painful stimulus.
• The stun is deep. Profound deafness is manifested by severe disorientation in space and time. The victim is in a state of deep drowsiness. Questions are usually followed by monosyllabic answers. The response to a painful stimulus occurs within normal limits. The victim is only able to perform simple tasks.
• Soporous state leads to deep depression of consciousness, but at the same time, protective reflexes to the influence of painful stimuli are preserved. This condition is characterized by pathological drowsiness; the victim cannot change his position and constantly lies on the bed with his eyes closed. There is an involuntary act of urination and defecation due to lack of control over the sphincters.
• Coma is moderate. The concept of coma is understood as an unconscious state in which there is a complete lack of perception of the surrounding world. A victim in a moderate coma cannot be awakened. The eyes do not open to painful sensations, but the limbs withdraw. The swallowing reflex is usually difficult. There are no changes in the functioning of vital organs that could threaten the life of the victim.
• Deep coma. Deep coma is characterized not only by an unconscious state, but also by the absence of defensive reactions to a painful stimulus. Deep coma is characterized by pronounced changes in cardiac and respiratory rhythm.
• Terminal coma. In this condition, a complete absence of muscle tone is detected. In contrast to moderate and deep coma, critical, sometimes incompatible with life, disturbances in the functioning of the cardiovascular system are observed. Blood pressure drops below 60 mm Hg. Art., tachycardia or bradycardia is pronounced. In the functioning of the respiratory system, long periods of cessation of breathing are noted, as well as pathological breathing of Cheyne-Stokes, Biot and Kussmaul.

Condition of vital organs

There are the following types of disorders in the functioning of vital organs:

• No violations. The respiratory rate is 12–18 breaths per minute. No pathological types of breathing are detected. Heart rate is in the range of 60 – 90 beats per minute. The upper limit of blood pressure does not exceed 110 – 140 mm Hg. Art., and the lower - 60 - 80 mm Hg. Art. Body temperature is normal and does not exceed 37°C.
• Moderate violations are to detect moderate bradycardia ( heart rate is 51 – 59 beats/min.) or moderate tachycardia ( Heart rate is 81 – 100 beats/min.). Mild hypertension is also determined ( 140/80 – 180/100 mmHg. Art.). The respiratory rate is increased, moderate tachypnea is detected ( 20 – 30 breaths.). Body temperature is between 37 – 37.9°C.
• Pronounced violations. Severe bradycardia or tachycardia is observed ( less than 50 or more than 120 beats/min.), as well as severe bradypnea or tachypnea ( less than 10 or more than 30 breaths.). Body temperature is usually between 38 – 38.9°C.
• Gross violations. Extreme tachycardia or bradycardia is detected ( over 120 or less than 40 beats/min.). Blood pressure exceeds 220/120 mmHg. Art. There is an increase in body temperature within the range of 39 – 39.9°C.
• Critical Violations in the functioning of vital organs lead to death if resuscitation measures are not taken in time. These disorders are characterized by periodic shallow breathing with long periods of apnea, a drop in blood pressure below 60 mmHg. Art., tachycardia, in which it is impossible to calculate the heart rate, as well as an increase in body temperature over 40°C.

Neurological disorders

The following types of neurological disorders are distinguished:

• No violations. The size of the pupils of both eyes is the same. There is a normal response of the pupils to a light stimulus in the form of constriction. Normal tendon reflexes are detected ( mechanical stimulation of the tendon with a hammer leads to muscle contraction), from the extremities, motor and sensory innervation is completely preserved.
• Moderate violations characterized by mild anisocoria, clonic nystagmus, and speech disorders. It is often possible to observe paresis of one arm or leg.
• Pronounced violations. With severe disorders, pathological dilation of the pupil of one eye occurs ( damage to only one oculomotor nerve). There is also a weakened reaction to a light stimulus. Severe disorders are characterized by the presence of meningeal symptoms. Muscle tone and tendon reflexes weaken on the affected side ( depending on where the lesion occurs in the right or left hemisphere). Typically, limb cramps can be detected.
• Gross violations characterized by a floating gaze ( a complex of symptoms that occurs with massive lesions of the occipital and frontal lobe). Multiple convulsions and paralysis in the limbs may occur.
• Critical violations. Bilateral dilation of the pupils and a complete lack of reaction to the light stimulus are detected. Critical disorders are characterized by a complete absence of muscle tone, as well as the absence of any reflexes. There is paresis of three or four limbs, as well as constant convulsive seizures.

Additional tests to detect brain contusion

Mild brain contusion

Moderate brain contusion

Severe brain contusion

The remaining half of the cases are characterized by a predominance of hemorrhage over destructive lesions of brain structures. With massive hemorrhage, the brain tissue is saturated with blood. In this situation, computed tomography reveals a massive zone of increased density. After 5 weeks, this zone gradually decreases in size, and connective tissue forms in place of the necrotic tissue.

How to provide first aid for a closed head injury?

If the victim is unconscious, he should be laid on his side and ensure a stable position. In this position, the tongue will not roll back. To do this you need the lower hand ( in relation to the victim's body) bend at the elbow joint and place the upper one under your head. The lower leg should be straightened, and the upper leg should be bent at the knee and hip joint at an angle of 90°. You should also carefully examine the oral cavity for the presence of vomit, since vomiting is characteristic of a traumatic brain injury. Vomit is removed using the index and middle fingers, which are pre-wrapped in rag material ( scarf, bandage).

If the victim is conscious, do not raise him to his feet. Only the position lying on your back or side is allowed. The prone position is not recommended, as this further irritates the stomach and can lead to a gag reflex. Upon arrival of the ambulance, the victim must be taken to the neurosurgical or intensive care unit.

What is the difference between a concussion and a brain contusion?

Comparison table of concussion and brain contusion:

How is a brain contusion treated?

Conservative treatment method

In conservative treatment, the following scheme is used:

• Respiratory therapy appears in the event of a violation of the breathing rhythm, the appearance of pathological Cheyne-Stokes, Biot breathing, periods of respiratory arrest, as well as a decrease in the oxygen content in the blood ( blood oxygen saturation less than 90%). In this situation, tracheal intubation is performed and a ventilator is used. The main goal of respiratory support is to normalize external respiration and maintain normal oxygen concentrations in arterial blood. If respiratory therapy lasts more than 48 hours, it is necessary to perform a tracheotomy ( a surgical procedure that allows temporary communication between the trachea and the environment).

• Infusion therapy ( intravenous infusion) is the main link in conservative therapy, since more than half of victims diagnosed with brain contusion are in a hypovolemic state ( decrease in circulating blood volume). Hypovolemia can be a consequence of cerebral hemorrhage, hyperthermia, repeated vomiting, and also occurs with some concomitant diseases ( for example, diabetes insipidus). Adjusting the volume of circulating blood leads to normalization of the heart rhythm and avoids the occurrence of secondary cerebral ischemia, which significantly reduces the chance of death. Infusion therapy involves maintaining cerebral perfusion pressure at 60–70 mm Hg. Art. It is worth noting that in each individual case, infusion therapy is selected taking into account the volume of lost blood, the level of blood oxygen saturation, as well as taking into account associated factors that affect the water-salt balance.

• Correction of intracranial pressure. Continuous monitoring of intracranial pressure is an absolute necessity in cases of moderate to severe brain contusion. In the context of adjusting intracranial pressure, basic and emergency therapy are distinguished.

Emergency therapy
Emergency therapy is carried out when intracranial pressure increases above 21 mmHg. Art. At the initial stage, a CT scan of the brain is performed to exclude the presence of causes that require surgical treatment. At the next stage, you can use an intraventricular catheter through which cerebrospinal fluid is discharged. It is also possible to use hyperventilation, which can temporarily reduce intracranial pressure. In some cases, a mannitol solution is prescribed intravenously at a dose of 0.25 - 1.0 cubic meters / 1 kg of body. This diuretic ( diuretic) helps to reduce the volume of circulating blood and, as a result, also lowers intracranial pressure. In cases where intracranial pressure does not respond to drug treatment, they resort to an induced coma ( in this state, the cerebral cortex is less susceptible to primary and secondary damage). For this purpose, sodium thiopental is used at a dose of 4–8 mg/1 kg. If drug treatment does not lead to the expected result, it is necessary to use decompressive craniotomy.

• Neuroprotective therapy used to shield nerve cells from the effects of secondary damage and promote the normal recovery and reparative process in the gray and white matter of the brain. It is worth noting that the use of a group of drugs with neuroprotective action ( glucocorticoids, calcium channel blockers, antioxidants, barbiturates) is not entirely correct. The fact is that with a brain injury, a whole chain of pathological processes occurs that have different origins and lead to different consequences. Also, to achieve a certain result, drugs from this group should be used in the first 6 to 8 hours after a traumatic brain injury. The following drugs have proven themselves well in therapeutic practice: erythropoietin, progesterone, statins and Ceraxon.

Neuroprotective drugs

Surgical method of treatment

Indications for surgery for brain contusion:

• Massive traumatic edema can be detected using computed tomography. This pathological formation has a reduced density in relation to the surrounding tissue. Traumatic edema leads to severe neurological symptoms, increased intracranial pressure over 25 mm Hg. Art., which sometimes does not respond to drug treatment.
• Deterioration of the general state of consciousness. If the victim is in a stuporous or comatose state, and in the dynamics there is a tendency towards increased disturbances in the functioning of vital organs, then this is an indication for urgent surgery.
• Extensive area of ​​crushing of brain tissue. If computed tomography reveals a massive crush zone of brain tissue that exceeds 20 cm³, and dislocation of brain structures also occurs, then this is an indication for surgery. Surgical treatment is also necessary if an intracerebral hematoma is detected that is more than 4 cm in diameter.

There are 3 schemes for surgical treatment of brain contusion:

• Removal of the focus of crushed brain tissue and osteoplastic craniotomy. Osteoplastic craniotomy is used as a broad access to brain tissue. Access to the brain structures is achieved by cutting out a large bone segment, which, after the end of the operation to excise the crushed brain tissue, is placed in its original place.
• Removal of the focus of crushed brain tissue and decompression craniotomy. Decompression trephination is performed to reduce intracranial pressure or if cerebral edema increases in size. The essence of decompression trephination is to create a permanent open area in the bones of the skull, as well as the dura mater. To do this, as a rule, a section of the temporal bone is excised. This area is subsequently covered by the temporal muscle, which serves as a new protective barrier and prevents injury.
• Decompression craniotomy without removal of the crush zone of brain tissue used only when the crush zone is significantly smaller than the zone of transient damage. In this case, only decompression is performed to normalize intracranial pressure.

Consequences of a brain injury

Every traumatic brain injury leads to degenerative processes. These include traumatic edema, tissue necrosis, hemorrhage, and tissue atrophy. At the same time, the body observes restorative and reparative processes that perform a compensatory function - cellular regeneration, hyperplasia, hypertrophy, sclerosis ( replacement of any type of tissue with connective tissue). These processes ultimately cause the consequences of a brain injury.

Clinically, there are 3 groups of clinical forms of consequences:

• fabric;
• liquorodynamic;
• vascular.

Tissue consequences

The following types of tissue consequences are distinguished:

• Post-traumatic brain atrophy characterized by a decrease in the volume of gray and white matter of the brain. This consequence occurs as a result of inflammatory-dystrophic processes - ischemia of brain tissue, demyelination of axons ( nerve cell processes lose their special protective layer), gliosis ( replacement of nerve cells with glial cells), decrease in the number of capillaries ( the smallest vessels) in the brain. With this pathology, expansion of the ventricular system of the brain is observed.

• Post-traumatic arachnoiditis. This pathological process develops in the soft and arachnoid membrane of the brain and leads to fibrosis ( compaction due to proliferation of connective tissue) these shells. Fibrosis of the arachnoid and soft membrane leads to the formation of adhesions, which causes disruption of the circulation of cerebrospinal fluid and the formation of cystic structures. Enlargement of the ventricles of the brain is also observed. The mechanism of occurrence of post-traumatic arachnoiditis is characterized by autosensitization of the body to brain tissue ( the body attacks its own cells).

• Post-traumatic pachymeningitis is an inflammation of the dura mater and occurs as a result of a violation of its integrity when damaged. This pathology is characterized by headache, which is located mainly above the brow ridges. Nausea, vomiting, decreased heart rate, and facial flushing are also observed ( hyperemia). In some cases, post-traumatic pachymeningitis manifests itself as seizures.

• Meningeal scars. These post-traumatic scars are formed in places of exposure to a traumatic factor. Meningeal scars are characterized by a predominance of epileptic syndrome. Also, this pathology often leads to the emergence of psychopathy ( decreased inclination to empathize with other people, egocentrism).

• Cranial nerve lesions, as a rule, prevail over other consequences. If the optic nerve is damaged, the victim may experience a sharp decrease in vision up to blindness. Paresis of the facial and glossopharyngeal nerves is also possible, which leads to partial or complete loss of motor sensitivity.

• Skull defects occur as a result of depressed fractures of the skull bones or during decompression or resection craniotomy. Skull defects manifest themselves in the form of trepanned skull syndrome - local pain at the site of exposure to a traumatic factor, which occurs and intensifies when meteorological conditions change. Often, protrusion of brain structures through the defect is observed when coughing, sneezing and physical activity.

Liquorodynamic consequences

The following types of liquorodynamic consequences are distinguished:

• Post-traumatic hydrocephalus- a process in which excess cerebrospinal fluid accumulates in the ventricular system, as well as in the gray and white matter of the brain. This pathological process is observed in the event of a violation of the outflow of cerebrospinal fluid, which leads to a compensatory increase in the ventricles of the brain. Clinically, post-traumatic hydrocephalus is manifested by a decrease in mental abilities, as well as memory impairment. The period of development of hydrocephalus can vary - from one month to a year.

• Post-traumatic porencephaly characterized by the formation of channels that communicate with the cavity of the ventricles of the brain and nearby brain structures. With this pathology, in most cases, epileptic syndrome predominates, as well as constant moderate headaches.

• Post-traumatic subdural hygroma– accumulation of cerebrospinal fluid under the dura mater, which leads to compression of the brain. Manifestations of post-traumatic subdural hygroma can be constant headaches, nausea, vomiting, and increased fatigue. This symptomatology is a consequence of increased intracranial pressure.

• Post-traumatic cerebrospinal fluid cyst. This cyst forms in the place where resorption of the hematoma occurs ( cavity with oozing blood) or crushed tissue. In most cases, a cerebrospinal fluid cyst manifests itself in the form of epileptic seizures.

• Post-traumatic pneumocephalus- a process in which the cranial cavity loses its tightness ( penetration of atmospheric air into the cranial cavity). Air can accumulate under the dura or arachnoid membrane of the brain, as well as in the ventricular system. Subjectively, post-traumatic pneumocephalus feels like a “water transfusion” when the position of the head changes. The clinical picture is dominated by headache, nausea, vomiting, and seizures.

Vascular consequences

The following types of vascular consequences are distinguished:

• Ischemic lesions are the most common cause of secondary brain damage. Cerebral ischemia can occur as a result of exposure to the following factors: traumatic cerebral edema, increased intracranial pressure, impaired blood flow in the brain tissue, low blood pressure, hypoxemia ( decreased oxygen concentration in the blood). Most often, these disorders occur in the area fed by two large arteries. Cerebral ischemia is characterized by deterioration in general condition, paresis or paralysis of the limbs, convulsive seizures, severe headache, and speech impairment.

• Chronic subdural hematomas can form due to traumatic brain injury of any severity. These types of hematomas are located under the dura mater and have their own connective tissue capsule. The clinical picture can be varied and resemble a stroke, encephalitis ( brain inflammation), epilepsy, brain tumor, psychosis ( serious mental impairment).

• Intracranial arterial aneurysms– protrusion of the artery wall due to disruption of the integrity of one of the layers of the blood vessel wall. Post-traumatic aneurysms are usually formed due to fractures of the base of the skull. The clinical picture depends on the size and location of the aneurysm. Thus, with an aneurysm of the carotid artery in the area of ​​the cavernous sinus ( one of the sinuses of the dura mater, which is located at the base of the skull) exophthalmos occurs ( bulging eyes), damage to the oculomotor nerve, local throbbing pain.

• Carotid-cavernous anastomosis- a communicating cavity between the carotid artery and the cavernous sinus. This pathological condition leads to impaired blood flow from the brain, cerebral hypoxia, decreased and loss of vision, as well as atrophy of brain tissue. When examining the eye, the following disorders are revealed: pulsation of the eyeball, swelling of the conjunctiva of the eye, dilation of the veins of the eye, double vision, impaired eye mobility.

There is no person on Earth who has never been bruised in his life. Of course, most often such troubles happen to us in childhood, but in adulthood we often suffer from bruises. What can I say, a bruise is an unpleasant thing, and the consequences from it are often simply disastrous. In this article we want to tell you about how to treat bruises, if something like this happens.

How to treat severe bruises

The word bruise in medicine means an injury to the muscle or bone tissue of the body without violating the integrity of the skin. A bruise is always accompanied by injury to blood vessels, which in turn causes the appearance of hematomas. Severe bruises require medical attention, but the consequences of minor bruises can be easily dealt with on your own at home. It is these methods that we want to talk about here.

Symptoms of bruises

As a result of a bruise, a person feels severe pain. Soon a tumor or edema appears in this place, and then bruising. In children and young people, these signs appear more clearly than in older people. This is due to age-related changes in the human circulatory system and muscle tissue.

How to treat a bruise

The first thing to do immediately after a bruise is to apply something cold to the injury site. It is best if it is ice, but a cold compress or a heating pad with cold water is also quite effective. As the compress warms up, it needs to be refreshed several times. In this way, it is usually possible to avoid the appearance of a tumor, and the pain noticeably subsides. A cold compress also prevents the bruising from spreading beyond the injury site. If you bruise your limbs, you should immediately apply a tight bandage.

After two to three days, the injury site should be warmed up using a warm heating pad or warm compresses. Warm baths and UHF therapy sessions help very well. As for massages, they can be done after the pain has completely disappeared. Massage helps especially well with joint bruises.

Pharmacy products for the treatment of bruises

Pharmacies sell very effective ointments and gels, which contain non-steroidal drugs that relieve inflammatory processes. They must be used according to the instructions supplied with them. Typically, these products contain substances such as diclofenac sodium, ibuprofen and ketoprofen. Ointments and gels are applied to the injured area at least four times a day, rubbing them into the skin over the entire surface of the injured area. It should be borne in mind that if there is a wound or cut at the site of the bruise, these drugs cannot be applied to the wound or cut itself. Only undamaged skin can be coated. It is clear that if the bruise is small, then a little ointment or gel should be rubbed in. If it is strong, then you need to rub it more and even more often than four times a day.

If the injury is very serious, then how to treat bruises Of course the doctor decides. For severe pain, analgesics or NSAIDs are usually prescribed, which are taken orally. These medications include diclofenac potassium, ibuprofen, ketoprofen and naproxen.

Treatment of bruises with traditional methods

From time immemorial, our ancestors treated bruises with medicinal herbs. Their recipes have survived to this day and are still used, especially in rural areas. In this article we want to introduce you to some of these recipes.

This method may seem a little strange. You need to take a small piece of pure linen fabric and grind it as much as possible. Mix the resulting powder with vegetable oil in a ratio of one to four. This mixture should be applied to the bruise site and covered with cellophane or a very thick cloth. After about an hour, you need to completely remove the medicine and wash the skin. If discomfort arises, the bandage can be removed earlier.

Traditional medicine claims that viper fat anesthetizes the bruise and heals it. If such fat is available, then it should be rubbed very carefully into the skin in a small amount.

An infusion of arnica flowers accelerates the healing of bruises. You can also make compresses from this infusion and apply it to the injured area of ​​the body. It soothes pain, relieves inflammation and localizes bruising. To prepare the infusion, you need to take one teaspoon of dried arnica flowers and pour one glass of boiling water over them. Close the container and leave the contents in a dark place for two hours, then strain. The infusion is taken orally three times a day before meals, one tablespoon. Exactly the same infusion can be made from arnica roots. The medicine has similar properties as the flower infusion.

Undoubtedly, traditional medicine does not downplay the role of bodyaga. This is an excellent remedy for bumps and bruises. If you use a bodyguard immediately after a bruise, there may not be a bruise at all. You can prepare the solution at home. To do this, take two tablespoons of chopped bodyagi herb and pour four tablespoons of cooled boiling water over it. Mix the mixture into a paste and apply to the injury site. It is advisable to apply a gauze bandage. The action of the bodyagi begins immediately after it begins to thicken a little.

Traditional medicine also recommends using Epsom salt for bruises. It is particularly good at removing bruises. To do this, you need to make hot baths at the site of the injury from a saturated solution of Epsom salts. You need to take four hundred grams of Epsom salts in a bucket of water and dissolve it in the water. If your limbs are damaged, you can simply put your arm or leg in a bucket and keep them there for forty minutes to an hour.

A tincture of wild rosemary in alcohol or a decoction of these flowers helps very well with bruises. You need to rub the bruised area with this remedy twice a day.

Cabbage leaves are very good at retracting tumors. Simply apply a leaf of white cabbage to the site of injury and apply a bandage. Sheets need to be changed periodically. This is usually done after 30 - 60 minutes. When the swelling subsides, the procedure can be stopped.

But this is a truly exotic remedy. It turns out that boiled crushed beans also heal bruises. Bean puree should be applied to the bruised area for half an hour several times during the day. After each time, it should be washed off with warm water.

Even simple potatoes can heal bruises. There are two ways to use potatoes for these purposes. The first is to simply apply thin slices of potato to the sore spot. The second is to wrap the mashed potato mixture in gauze and also apply it to the bruise site. This compress can be left on even overnight.

A mixture of honey and aloe juice helps very well with bruises. These two components should be mixed in equal proportions and applied to the sore spot. This remedy also has analgesic properties and relieves inflammation.

A bruise is the most common type of injury. When a bruise occurs, soft tissues are damaged, but the integrity of the skin at the site of injury is not compromised. Only damage to various vessels and cells occurs.

A bruise can cause injury to any part of the human body, including internal organs.

Causes of bruises and their features

You can get injured everywhere. This can be a bruise when falling from a height onto a flat surface, or a blow from a blunt object is possible. No ruptures of the skin occur during a bruise, but the tissues under the skin and the skin itself suffer.

Typically, a bruise is combined with injuries such as concussions, abrasions, scratches, ruptures of internal organs, fractures and dislocations.

Types (degrees) of bruises

The types of bruises are usually systematized as follows:

• 1st degree. When trauma occurs, minor damage to the skin occurs in the form of small wounds and abrasions. They go away on their own in three to four days.
• 2nd degree. In this case, the injury is characterized by tissue rupture, which causes swelling and hematoma. After a bruise, a patient may experience sharp pain.
• 3rd degree. In this case, damage to tendons and muscles occurs, and dislocations are also possible. Such injuries are especially dangerous when the head, knees or tailbone are damaged.
• 4th degree. Disturbances are caused that are characterized by a complete change in the functioning of all human organs and systems. The condition may become critical.

Symptoms of bruises

The main symptoms that characterize bruises:

1. pain in the area of ​​injury;
2. the occurrence of hematomas and edema;
3. hemorrhage that occurs as a result of injury.

The main symptom that causes a bruise is pain. The intensity of the pain depends on the extent of the injury. Severe damage can cause long-term and significant pain. Typically, these injuries cause hematoma (bruising) in most cases. The color of the hematoma after a bruise can vary from dark red to purple, after a while it becomes blue or bluish-black.

After damage, traumatic swelling occurs, causing the affected tissue to increase significantly. The manifestation of a bruise largely depends on the location of the injury. Thus, if a joint is damaged, its mobility may be limited due to swelling.

Consequences of a bruise

The consequences of a bruise depend on the nature of the damage and the part of the body that was damaged as a result of the injury. The most significant are:

• Severe head contusion, which can cause more significant damage - brain contusion. This can lead to disruption of the functioning of the entire body.
• A bruise that occurs in the neck area, in some cases leads to impaired blood circulation in the vessels, which can cause brain hypoxia.
• If the spine is damaged, serious consequences can occur that impair motor activity and sensation in the legs due to compression of the spinal cord tissue.
• Abdominal bruising can lead to rupture of a person's internal organs, which can cause a life-threatening condition due to excessive blood loss and resulting peritonitis.
• Trauma to the chest leads to disruption of the heart. If the reflex zone is struck, death occurs.
• Bruise of the hand, finger, knee, leg are among the most common injuries and do not threaten human life. After the injury, the patient may experience pain and limited movement for some time.
• A nail bruise is a very painful injury depending on the force of the blow. This leads to the accumulation of a large amount of blood under the nail and complete rejection of the nail plate.
• A coccyx injury is a minor injury, but is accompanied by significant pain, so it can put the patient in bed for several days. The pain especially intensifies when sitting.

First aid for bruises

To treat a mild bruise, in which the pain goes away quickly and the hematoma is small, you can apply cold to the damaged area. The compress can be a cloth soaked in cold water, a container of cold water, or pieces of ice. Cold helps stop bleeding faster, thereby reducing swelling.

If a leg or arm is bruised, the injured limb should be prevented from moving. This position should be maintained until examined by a traumatologist or until an x-ray is taken.

Assistance for bruises, when there is significant damage, should be provided to the patient in a medical facility. Only a doctor can correctly assess the consequences of an injury. Symptoms of injuries that require immediate medical attention:

• if the victim develops weakness and loss of consciousness;
• pain increases;
• pain appears with any attempts caused by movement;
• there is a gradual deterioration of the condition.

Medicines should be taken strictly as prescribed by the doctor, especially painkillers.

Diagnosis of bruises

Initially, the specialist examines the place where the impact occurred. In case of leg, foot, ankle or knee injuries classified as contusion according to ICD 10 (International Classification of Diseases) , Depending on the nature of the damage, radiography is prescribed.

If internal organs are damaged due to injury, then an ultrasound may be prescribed.

If the abdomen is injured, the doctor asks the patient to take urine and blood tests. In addition to X-rays or ultrasound, the patient is prescribed tomography if necessary.

If necessary, laparoscopy is used to determine the presence of internal bleeding and the need for surgery.

Treatment in hospital and at home

Hospital treatment is necessary if significant damage occurs. If the bruise is an injury to the head, lower back, abdomen and chest, then the patient must be urgently hospitalized in the surgical department. After diagnosis, specialists decide on further treatment methods. In case of surgical intervention, ruptured tissues or organs are sutured and blood clots are removed.

If the patient has undergone an examination, and after it no serious damage was found, then he is prescribed painkillers, cold compresses and a gentle regimen for the damaged organ.

The following medications can be used to treat injuries:

• Preparations with anti-inflammatory properties for external use: “Dikul Balm”, “Deep Relief”, “Indovazin”.
• Ointments and creams that can help remove hematomas: “Rescuer”, “Lioton 1000”, etc.
• Ointments with vasodilating properties: “Apisatron”, “Capsicam”.

For minor injuries, you can treat them yourself using several of the following recipes:

1. Apply lotions prepared with decoctions of St. John's wort, plantain, and wormwood to the bruise site.
2. To treat damage, you can use tea leaves.
3. To relieve pain from bruises, you can do a light massage using essential oils of fir, lemon or geranium.
4. You can gently rub the bruised area with the Asterisk balm.
5. Badyaga is an effective remedy for removing tumors. The powder is diluted with water in the form of a paste and placed on the site of the injury, wrapped in a cloth or scarf.
6. Grate the potatoes and place the resulting mass on the site of the bruise for several hours.

Using such recipes, you can get rid of swelling and bruises in a short period of time, because a bruise is primarily damage under the skin and on the skin.

Prevention of bruises

Prevention of bruises primarily comes down to preventing injuries that occur at home and at work.

Special precautions must be taken by the elderly, children and pregnant women.

Various types of bruises that a person receives are always easier to prevent than to treat later in the case of particularly severe damage to various organs.

A hematoma on the leg after a bruise, fall, collision or blow is a common injury in sports, at work and even in everyday life. In most cases, a bruise caused by mechanical damage to tissue does not pose a serious health hazard and quickly goes away on its own. But this doesn't always happen. Sometimes these “blue” lumps cause significant discomfort to a person - they hurt, swell and interfere with movements.

In medical terms, a hematoma is a limited accumulation of blood due to vascular subcutaneous damage, formed under the influence of a traumatic factor. However, if hematomas on the legs appear systemically and without obvious reasons, this may indicate the presence of some kind of disease (hemophilia, atherosclerosis, etc.).

Sometimes coagulated blood at the site of a bruise causes various negative consequences, which can only be eliminated surgically.

Shulepin Ivan Vladimirovich, traumatologist-orthopedist, highest qualification category

Total work experience over 25 years. In 1994 he graduated from the Moscow Institute of Medical and Social Rehabilitation, in 1997 he completed a residency in the specialty “Traumatology and Orthopedics” at the Central Research Institute of Traumatology and Orthopedics named after. N.N. Prifova.

The risk of getting hematomas increases during sports, outdoor activities and in everyday life in the event of a collision, fall or impact with a heavy object.

Hematomas after a bruise on the legs are divided into the following types:

1. Subcutaneous. Such injuries are characterized by rupture of capillaries; outwardly they look like an ordinary bruise. In most cases, they are recorded in the lower leg and thigh area. Symptoms of injury: pain in the area of ​​the bruise, tissue swelling, redness and bluishness of the skin. After a couple of days, the bruise turns green, turns yellow, and then disappears.
2. Soft tissue hematoma (internal). Hematoma affects muscle fibers. When blood vessels are damaged, blood penetrates into the soft tissues, and when the affected area is felt, a lump is felt. At the site of the formation of an extensive hematoma, severe pain and pulsation are felt. Movement of the injured limb may be difficult. The color of the hematoma ranges from bright red to purple.
3. Intra-articular. When a knee is bruised, hemorrhage occurs in the joint cavity (hemarthrosis occurs). It swells, becomes hot to the touch and is very painful. Movement of the injured leg brings unbearable pain caused by stretching of the joint capsule.

Fact! Sometimes, after receiving a hematoma, the victim’s body temperature rises.

Depending on the location of the bruise, hematomas are distinguished on the thigh, toes, foot, ankle, etc.

First aid for injury

First aid provided in the first minutes after a bruise plays a very important role. Correct actions immediately after injury help reduce pain and stop hemorrhage, preventing further growth of the hematoma. In this case, we are not talking about small bruises that resolve on their own. Emergency care is necessary for extensive hematomas on the leg after severe bruises.

What should you do after a bruise appears on your leg?

1. First - determine the degree of injury, make sure there is no fracture.
2. Next step - providing peace to the victim and injured limb. If the bruise occurs on the fingers, then doctors recommend reducing the load on the sore leg and taking off your shoes. If the pain is severe, you should immediately consult a traumatologist who can diagnose the severity of the injury.
3. If the bruise affects the knee area, then you need to elevate the leg(place a pillow or cushion under it). Under no circumstances should you bend your knee.
4. For 15-20 minutes to the bruised area apply cold(ice pack, cold bottle, etc.), the procedure is repeated every hour. It is contraindicated to steam the hematoma in the first two to three days, or apply heat to the site of its formation.

Interesting! Cold blocks further bleeding, helps reduce tissue swelling and constrict blood vessels.

1. If after a bruise there is an open wound on the leg, it must be treated with an antiseptic, apply a loose, comfortable bandage, seek help from a traumatologist or surgeon. The doctor diagnoses the severity of the injury and, if necessary, prescribes an X-ray examination.

Treatment of hematoma on the leg after a bruise

Small hematomas are treated conservatively in most cases. In case of severe bruises that lead to the formation of extensive internal hematomas, surgical intervention may be necessary - surgery to remove accumulated fluid, surgical restoration of blood vessels, etc.

Conservative treatment

Hematomas of mild and moderate severity are treated with medications that improve blood circulation, promote the resorption of bruises, and relieve pain and swelling: gel Lyoton, Dolobene, Trombless, “Rescuer”, Troxevasin, heparin ointment, Ketonal, Fastum-gel, “Dikul” and etc.

Sometimes physiotherapy may be required to speed up the regeneration process: electrophoresis, magnetic therapy and etc.

The victim is prescribed analgesics and vitamins. If necessary, three days after the injury, the leg is additionally lubricated with warming ointments and compresses are made. To relieve the limb, fixing bandages are used when walking.

Interesting! Ascorbic acid strengthens the walls of blood vessels and reduces capillary fragility.

Surgical methods of treatment

Methods of surgical treatment:

• stopping bleeding through surgery;
• puncture - “suction” of the contents of the hematoma with a syringe;
• surgical restoration of the anatomical integrity of a tendon or muscle;
• osteosynthesis and suture of the patella for hemarthrosis, drainage, etc.

The postoperative period requires long-term restoration of limb function. In case of hemarthrosis, a plaster splint is applied to immobilize the joint.

Hematomas of mild to moderate severity disappear after a few days. Full recovery from surgery may take up to several weeks or months.

Hematoma without an external cause

Sometimes hematomas on the legs are formed due to the development of certain diseases and pathological conditions:

1. Varicose veins
2. Inflammatory vascular diseases.
3. Pathological fragility of blood vessels.
4. Diabetes.
5. Hemophilia and other bleeding disorders.

Hematomas can also appear after taking certain medications, during the period after phlebectomy, etc.

Possible complications

Even a small and seemingly harmless bruise, if treated incorrectly, can lead to serious consequences, for example, suppuration of the bruise. Internal hematomas are sometimes accompanied by infection and purulent inflammation. When the damaged skin peels off at the site of the bruise, traumatic lumps (cysts), which can only be removed through surgery. If bed rest is violated after surgical treatment, it is possible re-accumulation of blood in the joint(hemarthrosis). Severe injuries and extensive bruising can lead to tissue necrosis.

Under no circumstances should hematomas, especially large ones, be left without the attention of doctors.

Of course, accidental injury cannot be prevented in advance, but its consequences can be minimized. To strengthen blood vessels, muscles and bones, you need to eat a balanced diet, lead a healthy lifestyle and exercise - all this together will help prevent the development of serious complications after bruises.

What to do if you didn’t hit yourself anywhere, but bruises appear on your skin?