Hematomas… How I Treated Myself After Sustaining A Good Blow To The Head!

“Sometimes we need a 2x4 to the side of the head to wake us up.”

Here’s another “Physician, Heal Thyself” story that might help you – this time from my work in acute medicine.

Not long ago, I helped a friend with a carpentry project in his garage. Lumber and tools and people moved about rapidly. In a moment of inattention and miscommunication, my forehead and a 2x4 tested what happens when two objects attempt to occupy the same space at the same time. The 2x4 won decisively. The blow to my forehead was sharp. I knew no serious damage was done to my skull and brain, so in the spirit of being “a real man,” and one who did not want to shirk my duties when others around me were working hard, I “shook it off” and kept working.

That proved to be a foolish move.

As I knew from the many facial lacerations I have sutured, the forehead is well endowed with blood vessels – a vast network of small arteries and veins. A sharp blow is likely to burst one or two vessels, allowing blood to pour into the surrounding tissues – which was, of course, exactly what happened.

Within 15 minutes, my friend told me to look in a mirror. Much to my dismay, a large, tender lump was growing under my skin in the middle of my forehead – a classic “goose-egg.” This was a hematoma (literally, a lump of blood) and it was growing larger by the minute, since facial tissues are fairly loose and allow blood to track freely under the skin.

I now had to do what I should have done immediately – apply direct pressure to stop the bleeding under the skin – the same way one stops bleeding when a wound is open. I found a place to sit down. I did not want to lie down and have more blood rush to my head which would increase the bleeding; instead, I wanted gravity working for me. So, I tilted my head back with my forehead facing up toward the ceiling and I wrapped an ice pack in a washcloth (to protect my skin from too much direct cold).

Why the ice pack? Cold constricts blood vessels and slows down blood flow in the area to reduce bleeding. I applied gentle, but firm pressure to the area for a good 40 minutes, a sufficient time for my natural clotting mechanisms to seal the tears in the blood vessels and stop the bleeding.

The pressure I had to apply was uncomfortable because I was pressing down on the hematoma which had already formed. In the weeks that followed, the accumulated blood found its way to the surface and a large bruise emerged, changed color, and slowly faded – all in plain sight of my patients, colleagues and friends.

In retrospect, after feeling such a sharp blow to such a vascular area, I should have sat down immediately, tilted my head back, and applied very firm pressure right away and held it for a good 30-40 minutes, with or without an ice pack. The torn vessels would have sealed in the first few seconds, before much blood escaped into the surrounding tissues, and the swelling, bruising and discoloration would have been minimal, and, likely, barely visible.

The lesson? Any time you get knocked hard enough to think blood vessels may have been torn and tissues might bruise, stop what you are doing, if you can, elevate that part of your body, and apply firm pressure for at least 30 minutes. If you do so, you can often reduce the swelling, pain and discoloration that usually follows.

If you can apply ice, all the better, but do so only for 5-15 minutes at a time. Take the ice pack away for 10 minutes and continue holding pressure with the hand or cloth until the time for the next cold application.

Remember: Take time to take care of yourself. You’re worth it!

To your good health and happiness,

Dr. Michael Klaper