▷ FIRST AID: for CONTUSIONS and INJURY. MANAGEMENT and TREATMENT

Bruising occurs when a contusion causes the rupture of small vessels in the subcutaneous cellular tissue and sometimes in the dermis of the skin itself, allowing a small amount of blood to infiltrate between the different elements that make up these tissues.

A purple-coloured spot is then observed at the site of the contusion, which over time becomes greenish and then yellowish, until it disappears. This change in the colour of the bruise is due to the transformation of the blood pigment into bile-like pigments.

There is also pain and slight swelling of the bruised area. Bruising will be observed not only in bruises, but also in bruised wounds, sprains or twists and fractures. In the latter case, the bruising is usually delayed.

Hematomas occur when the bruise breaks larger vessels, spilling a greater quantity of blood, which can infiltrate the subcutaneous cellular tissue and the muscles, or, by separating the neighboring elements, form a collection or localized accumulation of blood.

The hematoma can be located anywhere on the body. Common locations are the eyelids and the scalp. In the latter case it is commonly called a bump.

The symptoms of hematomas are: a localized and quite marked protrusion at the site of the trauma, often with the pain described when talking about ecchymosis. In the case of blood collection, the so-called blood crepitation can be felt for a few hours when palpating the hematoma, crepitation that is due to the rupture of the recently formed clots.

When the hematoma is found on the scalp, it can be felt that, after a while, there is a relatively hard ring and a softer area in the center, which could lead one to believe that there is a localized sinking of the bones of the skull.

It is observed, however, that by pressing for a certain time with the finger on a point of the ring, it becomes depressed, which would not happen if it were made up of a bony ridge.

The procedure, management and treatment for applying first aid for contusions is as follows:

• In the first few hours a) keep the affected part elevated, b) place cloths soaked in cold or ice water on it, which will be renewed frequently, or an ice pack. The aim of this treatment is to try to stop the bleeding from the vessels that have been torn in the injured tissues. It is unlikely that the bleeding will continue after 12 hours.

• After 24 hours, help the reabsorption of the spilled blood and the edema (or swelling) with alternating applications of heat and cold.

• Apply heat for 3 minutes and cold for half a minute, for approximately 20 minutes.

• Start with heat and finish with cold.

• If it is an extremity, this treatment can be done by placing it alternately in a container with water as hot as it can be tolerated (adding hot water if necessary), and in another containing water as cold as possible.

• If the affected part cannot be immersed in water, the same treatment can be carried out using hot compresses and cold cloths in a similar manner.

• The frequency of this treatment will vary according to the intensity of the blow and the discomfort it causes. It may be applied every four hours at first, and then two or three times a day.

• For large bruises, it may sometimes be necessary to evacuate their contents by puncture or lancing. A similar treatment may be indicated in the case of traumatic serosal discharge.

• The decision as to whether these measures are necessary and whether medications to help reabsorb the blood or other fluids should be administered is left to the physician's discretion.