From the Research
The management of an intramuscular hematoma primarily involves the RICE protocol: Rest, Ice, Compression, and Elevation, as well as consideration of the patient's overall clinical condition, including the size and cause of the hematoma, timing of diagnosis, and degree of neurological impairment 1. The RICE protocol is essential in the initial management to prevent further bleeding and damage. Rest the affected muscle, apply ice for 15-20 minutes every 2-3 hours during the first 24-48 hours, use compression with an elastic bandage to limit swelling, and elevate the affected limb above heart level when possible. Pain management is also crucial and typically includes acetaminophen (500-1000mg every 6 hours as needed) or NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) if not contraindicated, avoiding aspirin due to its potential to increase bleeding 2. For patients with severe haemophilia, management may involve specific factor replacement therapies and a more tailored approach to rehabilitation, emphasizing the importance of a multidisciplinary team including clinicians and physiotherapists 3. In cases where bleeding is a concern, the use of tranexamic acid (TXA) has been explored, with studies indicating its potential effectiveness in reducing bleeding when administered intramuscularly, offering an alternative in scenarios where intravenous access is challenging 4. Surgical intervention, although rarely needed, may be considered for very large hematomas causing compartment syndrome, persistent pain, or neurological symptoms, highlighting the need for careful monitoring and individualized treatment plans 1, 5. Ultimately, the goal of management is to minimize morbidity, prevent mortality, and optimize the patient's quality of life, which may involve a combination of these strategies tailored to the individual's specific condition and needs.