What is a hematoma?
The blood vessels in the body are under constant repair. Minor injuries occur routinely and the body is usually able to repair the damaged vessel wall by activating the blood clotting cascade and forming fibrin patches. Sometimes the repair fails if the damage is extensive and the large defect allows for continued bleeding. As well, if there is great pressure within the blood vessel, for example a major artery, the blood will continue to leak and the hematoma will expand.By definition, a hematoma is a collection of blood outside of a blood vessel. It occurs because the wall of a blood vessel wall, artery, vein or capillary, has been damaged and blood has leaked into tissues where it does not belong. The hematoma may be tiny, with just a dot of blood or it can be large and cause significant swelling.
Blood that escapes from the blood stream is very irritating and may cause symptoms of inflammation including pain, swelling and redness. Symptoms of a hematoma depend upon their location, their size and whether they cause associated swelling or edema.
The medical term ecchymosis is what most people would recognize as abruise, or blood that has leaked out of a broken blood vessel under the skin that is caused by an injury. Another word for this injury is a contusion. An ecchymosis tends to be flat while a hematoma has more of a three dimensional character to it. As well, hematomas may occur in any organand not just under the skin.
Hemorrhage
Hemorrhage is the term used to describe active bleeding. The term hematoma describes blood that has already clotted.
What causes a hematoma?
Trauma is the most common cause of a hematoma. When people think of trauma, they generally think of car accidents, falls, head injuries, broken bones, and gunshot wounds, etc.. Trauma to tissue may also be caused by an aggressive sneeze or an unexpected twist of a limb. When a blood vessel is damaged blood leaks into the surrounding tissue; this blood tends to coagulate or clot. The greater the amount of bleeding that occurs, the larger the amount of clot formation.
Blood vessels that are fragile may contribute to hematoma formation. For example, an aneurysm or weakening in a blood vessel wall may spontaneously leak.
There are many people who take blood thinners (anti-coagulation) medications. Examples include warfarin (Coumadin),aspirin, clopidogrel (Plavix) and prasugrel (Effient). These medications increase the potential for spontaneous bleeding and for hematomas to expand because the body cannot efficiently repair blood vessels and blood continues to leak through the damaged areas.
Occasionally, diseases may occur that decrease the number of platelets in the blood stream (thrombocytopenia) or their ability to function. The platelets are the cells that help initiate blood clot and fibrin formation.
All of the above situations may exist independently to cause a hematoma or they may occur together.
How is a hematoma diagnosed?
Comment on thisRead 3 Comments
Hematomas of the skin and soft tissues, such as muscle and joints, are often diagnosed by physical examination alone.
For patients exhibiting signs of internal bleeding, the health care practitioner will decide what imaging modality is best to evaluate the situation. Plain X-rays may be needed to assess for bone fracture. Patients with significant head injury often require CT scanning. Ultrasound is the testing modality of choice for pregnant patients.
What is the treatment for a hematoma?
Comment on thisRead 30 Comments
Hematomas of the skin and soft tissues are often treated withRICE (rest, ice, compression, elevation). Some health care practitioners may advocate heat as another treatment alternative. The pain of a hematoma is usually due to the inflammation surrounding the blood and may be treated with over the counter pain medications. The choice of medication depends upon the underlying health of the patient. For those patients who are taking anti-coagulation medications, ibuprofen is relatively contra-indicated because of the risk of gastrointestinal bleeding. Patients with liver disease should not take over the counter acetaminophen. When in doubt, it is wise to ask the health care practitioner or pharmacist for a recommendation.
Treatment for hematomas involving other organs in the body depends upon what organ system is involved. In these cases, treatment will be tailored to the specific situation.
What are the types of hematomas?
Hematomas are often described based upon their location.The most dangerous hematomas are those that occur inside the skull. Because the skull is an enclosed box, anything that takes up space increases pressure within that box and potentially impairs the ability of the brain to function.Epidural hematomas occur because of trauma, often to the temple, where the middle meningeal artery is located. Bleeding accumulates in the epidural space, outside the 'dura' which is the lining of the brain. Because of the way the dura is attached to the skull, small hematomas can cause significant pressure and brain injury.Subdural hematomas also occur because of trauma but the injury is usually to the veins in the brain. This causes a slower leak of blood, which enters the 'subdural' space below the dura. The space below the dura has much more room for blood to accumulate before brain function suffers. As people age, they lose some brain tissue and the subdural space is relatively larger. Bleeding into the subdural space may be very slow, gradually stop, and not cause acuteacute symptoms. These 'chronic' subdural hematomas are often found incidentally on computerized tomography (CT) scans as part of a patient evaluation for confusion or because another traumatic incident occurred.Intracerebral hematomas occur within the brain tissue itself. Intracerebral (intra= within + cerebrum=brain) hematomas may be due to bleeding from uncontrolled high blood pressure, an aneurysm leak or rupture, trauma,tumor or stroke.
Scalp hematomas occur on the outside of the skull and often can be felt as a bump on the head. Because the injury is to the skin and muscle layers outside of the skull, the hematoma itself cannot press on the brain. However, a scalp hematoma signals that there has been a head injury and it is important to assure that internal bleeding has not occurred within the skull. There are a variety of guidelines available to the health care practitioner to assist in accessing whether a patient will require further testing to explore any bleeding in the brain.
Aural or ear hematomas may occur if an injury causes bleeding to the outside helix or cartilage structure of the ear. Often called boxer's, wrestler's ear, or cauliflower ear, blood gets trapped between the thin layer of skin and the cartilage itself. Since the ear cartilage gets its blood supply directly from the overlying skin, a hematoma can decrease blood flow causing parts of the cartilage to shrivel and die. This scenario results in a bumpy, deformed outer ear.
Septal hematomas occur with nasal trauma. A septal hematoma may form associated with a broken nose. If not recognized and treated, the cartilage can break down and cause a perforation of the septum.
Orthopedic injuries are often associated with hematoma formation. Bones are very vascular structures since the marrow is where blood cells are made. Fractures are always associated with hematomas at the fracture site. Fractures of long bones such as the thigh (femur) and upper arm (humerus) can be associated with a significant amount of bleeding, sometimes up to one unit of blood or 10% of the body's blood supply.
Pelvic bone fractures can also bleed significantly since it takes a large amount of force to break these bones and it is very difficult to compress the area to decrease the amount of bleeding. Pelvic hematomas are hidden and the amount of blood loss may be difficult to assess.
Intramuscular hematomas can be very painful due to the amount of swelling and inflammation. Some muscles are surrounded by tough bands of tissues. If enough bleeding occurs, the pressure within these compartments can increase to the point that a 'compartment syndrome' can occur. In this situation, the blood supply of the muscle is compromised and the muscle and other structures such as nerves can be permanently damaged. This is most commonly seen in the lower leg and forearm.
Subungual hematomas are the result of rush injuries to the fingers or toes. Bleeding occurs under the fingernail or toenail and since it is trapped, pressure builds causing pain. Trephination, or drilling a hole through the nail to remove the blood clot, relieves the pressure and resolves the injury. A new nail grows over time.
Bruises and contusions of the skin (ecchymosis) are terms that describesubcutaneous hematomas. These occur due to trauma or injuries to the superficial blood vessels under the skin. Individuals who take anti-coagulant medication are more prone to subcutaneous hematomas.
Intra-abdominal hematomas and hemorrhage may be due to a variety of injuries or illnesses. Regardless of how the blood gets into the abdomen, the clinical finding is peritonitis (irritation of the lining of the abdomen). Hematomas may occur in solid organs such as the liver, spleen, or kidney. They may occur within the walls of the bowel, including the small intestine(duodenum, jejunum, ileum) or the large intestine (colon). Hematomas may also form within the lining of the abdomen called the peritoneum or behind the peritoneum in the retroperitoneal space (retro=behind).
Passing clots or hematomas is a common complaint when womenmenstruate. Blood can accumulate in the vagina as part of the normal menses and instead of flowing out immediately, it may form small blood clots. Passing blood clots after delivering a baby is also relatively common. However, vaginal bleeding and passing blood clots or hematomas whilepregnant is not normal and should be a sign to seek medical attention.
Hematomas may occur anywhere in the body. Regardless of how a hematoma is described or where it is located, it remains a collection of clotted blood outside of a blood vessel.
Scalp hematomas occur on the outside of the skull and often can be felt as a bump on the head. Because the injury is to the skin and muscle layers outside of the skull, the hematoma itself cannot press on the brain. However, a scalp hematoma signals that there has been a head injury and it is important to assure that internal bleeding has not occurred within the skull. There are a variety of guidelines available to the health care practitioner to assist in accessing whether a patient will require further testing to explore any bleeding in the brain.
Aural or ear hematomas may occur if an injury causes bleeding to the outside helix or cartilage structure of the ear. Often called boxer's, wrestler's ear, or cauliflower ear, blood gets trapped between the thin layer of skin and the cartilage itself. Since the ear cartilage gets its blood supply directly from the overlying skin, a hematoma can decrease blood flow causing parts of the cartilage to shrivel and die. This scenario results in a bumpy, deformed outer ear.
Septal hematomas occur with nasal trauma. A septal hematoma may form associated with a broken nose. If not recognized and treated, the cartilage can break down and cause a perforation of the septum.
Orthopedic injuries are often associated with hematoma formation. Bones are very vascular structures since the marrow is where blood cells are made. Fractures are always associated with hematomas at the fracture site. Fractures of long bones such as the thigh (femur) and upper arm (humerus) can be associated with a significant amount of bleeding, sometimes up to one unit of blood or 10% of the body's blood supply.
Pelvic bone fractures can also bleed significantly since it takes a large amount of force to break these bones and it is very difficult to compress the area to decrease the amount of bleeding. Pelvic hematomas are hidden and the amount of blood loss may be difficult to assess.
Intramuscular hematomas can be very painful due to the amount of swelling and inflammation. Some muscles are surrounded by tough bands of tissues. If enough bleeding occurs, the pressure within these compartments can increase to the point that a 'compartment syndrome' can occur. In this situation, the blood supply of the muscle is compromised and the muscle and other structures such as nerves can be permanently damaged. This is most commonly seen in the lower leg and forearm.
Subungual hematomas are the result of rush injuries to the fingers or toes. Bleeding occurs under the fingernail or toenail and since it is trapped, pressure builds causing pain. Trephination, or drilling a hole through the nail to remove the blood clot, relieves the pressure and resolves the injury. A new nail grows over time.
Bruises and contusions of the skin (ecchymosis) are terms that describesubcutaneous hematomas. These occur due to trauma or injuries to the superficial blood vessels under the skin. Individuals who take anti-coagulant medication are more prone to subcutaneous hematomas.
Intra-abdominal hematomas and hemorrhage may be due to a variety of injuries or illnesses. Regardless of how the blood gets into the abdomen, the clinical finding is peritonitis (irritation of the lining of the abdomen). Hematomas may occur in solid organs such as the liver, spleen, or kidney. They may occur within the walls of the bowel, including the small intestine(duodenum, jejunum, ileum) or the large intestine (colon). Hematomas may also form within the lining of the abdomen called the peritoneum or behind the peritoneum in the retroperitoneal space (retro=behind).
Passing clots or hematomas is a common complaint when womenmenstruate. Blood can accumulate in the vagina as part of the normal menses and instead of flowing out immediately, it may form small blood clots. Passing blood clots after delivering a baby is also relatively common. However, vaginal bleeding and passing blood clots or hematomas whilepregnant is not normal and should be a sign to seek medical attention.
Hematomas may occur anywhere in the body. Regardless of how a hematoma is described or where it is located, it remains a collection of clotted blood outside of a blood vessel.
What are the symptoms of a hematoma?
Comment on thisRead 1 Comment
Hematomas cause irritation and inflammation. Symptoms depend upon their location and whether the size of the hematoma or the associated swelling and inflammation causes structures nearby to be affected. The common symptoms of inflammation include redness, pain, and swelling.
In general, superficial hematomas of skin, soft tissue, and muscle tend to resolve over time. The initial firm texture of the blood clot gradually becomes more spongy and soft as the clot is broken down by the body and the shape changes as the fluid drains away and the hematoma flattens. The color changes from that of a purplish-blue bruise to yellows and browns as the blood chemicals gradually are removed and the hematoma resolves. Depending upon its location, the discolorations may travel through different tissue planes by gravity. For example, a forehead hematoma may cause bruising beneath the eyes and seem to travel to the neck as it resolves over time.
Intracranial, epidural, subdural, and intracerebral hematomas often need neurosurgical intervention to stabilize the injury.
When should I call my doctor about a hematoma?
Most hematomas have little consequence. They are due to minor trauma where the patient was aware of the injury, knows what part of the body was injured and can expect to recover with few problems. Bumps and bruisesare part of every child's growth.
Some hematomas may be more important because of their location and it is usually the nearby affected structures that cause symptoms. For example, medical care would be sought for a head injury victim for significantheadache, vomiting , or difficulty being aroused. Intracranial (intra= within + cranium=skull) hematomas need to cause pressure on the brain before symptoms manifest themselves, thus any significant head injury should be evaluated by a health care practitioner.
Patients taking blood thinners are at higher risk for bleeding from minor injuries. It is often wise for these people to seek medical attention if they are involved in even minor accidents or sustain minor injuries.
Can hematomas be prevented?
- Accidents happen and most hematomas are inevitable once the trauma has occurred.For patients taking anti-coagulation medications, it is wise to avoid participating in events with high risk of injury. For patients taking warfarin (Coumadin), it is important to make certain that the dosing is appropriate and the blood is not thinned excessively.
Hematoma At A Glance
- A hematoma is a collection of blood outside of a blood vessel.
- Symptoms of hematomas depend upon their location and whether adjacent structures are affected by the inflammation and swelling associated with the bleeding.
- Treatment of a hematoma depends upon which organ or body tissue is affected.
- Superficial hematomas of the skin and soft tissue, such as muscle, may be treated with rest, ice compression, and elevation. Heat may also be considered.
West Nile virus strikes early in the South Bay, may be to blame for death of Carson man
Posted: 07/31/2013 07:49:14 PM PDT
Updated: 07/31/2013 08:13:21 PM PDT
Los Angeles County vector Control personnel went door to door in Carson Wednesday leaving information on West Nile Virus prevention. Carson resident Martha Council gets information about West Nile Virus prevention from Vector Control Specialist Bryson Fong. (Robert Casillas / Staff Photographer)
A 78-year-old Carson man infected with West Nile virus died this week, and though county health officials have not yet officially linked his death to the mosquito-borne illness, they have confirmed that the South Bay appears to be ground zero for this year's early reports of West Nile in Los Angeles County.
Albert Shipman died Tuesday night at Little Company of Mary Hospital in San Pedro after doctors there diagnosed him with West Nile virus, according to family members. Shipman was hospitalized for two weeks before succumbing to symptoms that at first pointed to a mild stroke, said his son, Alfonso Shipman of Carson.
"He was experiencing loss of memory, slurred speech and pain on his right side," Shipman said. "Then finally, about 10 days ago, they said it's West Nile. ... We were just devastated."
Meanwhile, another hospital patient -- Anna Lee Taylor of Torrance -- also was diagnosed with West Nile virus after she was taken to Torrance Memorial Medical Center six days ago, said her daughter-in-law, Debbie Taylor.
"She went down (last) Thursday. She was semi-conscious and had a very high fever of 103.5," Debbie Taylor said. "She's had three spinal taps and blood cultures."
The blood report indicated she had encephalitis secondary to West Nile virus, she said.
Thus far, county
Advertisement
A map on the county's website shows a heavy South Bay concentration of birds and squirrels testing positive for West Nile virus from January to July 17. West Nile is transmitted to people and animals through the bite of an infected mosquito. Only one in five people infected will exhibit symptoms, but it can be deadly, especially to those older than 50, said Dr. Rachel Civen, epidemiologist for Los Angeles County.
"We're seeing the most West Nile virus in dead birds and mosquito pools than we've seen in many, many years in the Torrance area," Civen said. "Why, I don't know.
"Usually our focus is the San Fernando Valley and San Gabriel because, generally, they tend to be warmer. Peak months usually are from late August through September. It will be picking up."
Deaths from West Nile are rare; most who contract the virus don't exhibit anything more than mild symptoms.
But there were six deaths (from 174 reported human cases) in 2012 from West Nile virus, according
to the county health department's website. A total of three human cases were reported from the South Bay last year, Civen said.
"Last year was a really big year," she said.
An updated report will be posted by the end of this week atph.lacounty.gov/acd/vectorwestnile.htm/.
Because there is no treatment or cure, Alfonso Shipman said it's important that residents understand the virus can be deadly.
His father was "a huge man and just to be taken down by a mosquito like that ... people need to be aware," he said.
The rise in West Nile activity in the South Bay is "a bit of an anomaly," said Truc Dever, director of community affairs for the Greater Los Angeles County Vector Control District.
The agency attributes the early activity to weather conditions being "slightly" warmer -- by about 3 degrees -- than in past summers, Dever said, and also to what is thought to be a lower immunity among the bird population than in previous years.
Some of the earliest positive samples were found in mosquitoes near Machado Lake in Harbor City and the Wilmington Drain adjacent to the lake. Officials sprayed the area following the discovery.
Families of both Shipman and Taylor said there was no obvious point
Steps to protect against the threat of West Nile virus:
- Eliminate standing water in clogged rain gutters, rain barrels, discarded tires, buckets, watering troughs or anything that holds water for more than a week.
- Change the water weekly in bird baths
- Ensure that swimming pools, spas and ponds are property maintained and report neglected pools in your neighborhood.
- Request free mosquitofish from your local vector control district for placement in out-of-order swimming pools, spas and ponds.
- Wear insect repellent containing active ingredients such as DEET, Picaridin, or IR3535 when outdoors where mosquitoes are present.
- Wear long sleeves when outside at dawn and dusk when mosquitoes are most active.
- Source: -- Greater Los Angeles County Vector Control District
More information:
- Greater Los Angeles County Vector Control District:glacvcd.org/; 562-944-9656
- Acute Communicable Disease Control, county Department of Public Health (West Nile activity reports and maps posted weekly):http://ph.lacounty.gov/acd/vectorwestnile.htm/
- Neighborhoods currently being canvassed by vector control in Carson: http://goo.gl/maps/UqHAA
On Wednesday, vector control representatives canvassed a Carson neighborhood to caution residents about the presence of the virus and to share information on how to guard against exposure.
Altogether, three areas in Carson have been targeted for the door-to-door campaign.
"A lot of people are shocked," said Bryson Fong, one of the vector control specialists talking to residents Wednesday. Most, he said, were responsive to the offered property checks for standing water and other hazards that might put homeowners more at risk.
Carson resident Martha Council said she appreciated the brochures and other information the agency left at her front door.
"We do a lot outside," she said. "I don't live in fear (of it) but it's something we are aware of."
After the vector control specialists left, she said she'd make sure she applied insect repellent regularly.
Mosquito samples and dead birds collected throughout the agency's jurisdiction -- along with testing on the agency's sentinel chickens -- have yielded positive results for West Nile in Carson, Gardena, Harbor City, Wilmington, Long Beach, Lakewood and Bellflower.
Other areas where positive samples have been collected include Woodland Hills, Eagle Rock, Arleta, Mission Hills, Valley Glen, Toluca Lake, Valley Village, North Hollywood, Commerce, Lincoln Heights, Whittier, Norwalk, Downey, Bell Gardens, Bell, Huntington Park, Lynwood, South Gate and Paramount.
While there is no vaccine, cure or treatment, Civen said researchers have discovered a horse vaccine that appears to be effective against West Nile.
"They're working on it," she said. Until then, prevention is key. Wearing long sleeves and using a mosquito repellent at dusk and dawn are especially important, she said.
"It's very deceptive," she said of the uptick in positive samples being found in the South Bay. "Walking around in Rolling Hills Estates or San Pedro on the coast, it doesn't strike you that you should be worried about a mosquito-borne infection. But people really do need to be made aware" of the danger.
donna.littlejohn@dailybreeze.com
@donnalittlejohn on Twitter
I need to get Colby shots and he has doulble ear infections I don't know what to do
UPDATE 12-6-12 hematma in his ear flap not looking good not sure what to do at this point.........................
NOW THATS A BED!!
No comments:
Post a Comment