First aid for contusions

Action algorithm for the first 24 hours

The primary task in the first 24 hours after sustaining a contusion is to maximally limit the volume of internal bleeding into the soft tissues. The following tactics are used for this:

• Application of a pressure bandage directly to the site of the contusion.
• Use of cold. An ice pack is the optimal option, as it helps constrict blood vessels and reduce hemorrhage. Follow a strict regimen: cold is applied for 2 hours, followed by a 30–40 minute pause.
• Actions for hemarthrosis. If hemorrhage into the joint cavity has occurred, it is critically important to ensure complete rest. The injured limb must be elevated, and a tight pressure bandage applied to the joint itself.

Important: if concomitant bone injury is suspected, transport immobilization is mandatory for the victim even at the pre-hospital stage.

Treatment on days 2–3

After the first forty-eight hours, the treatment tactics change drastically. Cold is completely discontinued, as the risk of ongoing bleeding decreases. The stage of applying thermal procedures begins.

The patient is prescribed medical heating pads or warming with a Sollux lamp. Heat exposure is necessary to locally dilate blood vessels, improve microcirculation, and significantly accelerate the resorption of the already formed hemorrhage.

Tactics for large hematomas

If the volume of extravasated blood is large, conservative heat treatment may be insufficient. In such cases, minimally invasive surgical intervention is required:

1. On the 5th–7th day after the injury, the physician performs a hematoma puncture.
2. The accumulated liquid blood is completely removed via a needle.
3. Immediately after the procedure, a pressure bandage is applied to the affected area (not to be confused with an aseptic, occlusive, or plaster bandage — in this case, a pressure bandage is specifically required).

Management of concomitant superficial injuries

Contusions are often accompanied by superficial skin injuries — abrasions and minor wounds. The main goal of pre-hospital care is to stop bleeding from small vessels and prevent infection.

• Wound edges (the skin around the defect, but not the wound itself) are treated with an iodine solution.
• Bleeding is stopped by applying a standard bandage.
• For isolated abrasions, it is advisable to use film-forming agents as a primary dressing. They create a reliable protective film on the surface. After antiseptic treatment, further healing of such defects proceeds safely under a scab.

Outpatient treatment and primary surgical debridement (PSD)

Patients with contusions, abrasions, and small wounds are treated in an outpatient clinic. If the wound (incised, bitten, lacerated, puncture, or contused) requires edge excision and primary closure, primary surgical debridement (PSD) is indicated.

PSD is a set of measures aimed at rapid wound healing without complications. The procedure must be radical, single-stage, and definitive. It begins with wound toilet (cleaning the surrounding skin with warm water and soap, alcohol, hydrogen peroxide, or gasoline; shaving hair) and mandatory local or general anesthesia.

Class and exam questions

What else to study on this topic

• Differential diagnosis of incised and puncture wounds
• Specific symptoms of animal bite wounds
• Requirements for performing primary surgical debridement (PSD)
• Wound and operative field toilet before surgical intervention

Other topics in the "Additional Topics" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.