From the Research
For a patient with various stages of bruising showing yellow discoloration, triage should focus on determining the cause of bruising and assessing for any underlying medical conditions, with treatment primarily involving supportive care including rest, ice application for the first 24-48 hours, compression, and elevation of affected areas if possible. Initial assessment should include a thorough history to identify potential trauma, medication use (especially blood thinners), or bleeding disorders, as well as a physical examination to document the extent, location, and characteristics of bruises 1. Yellow bruising typically indicates an older bruise (5-10 days old) as hemoglobin breakdown products are being cleared. Some studies suggest that cooling treatments, such as ice packs or cold gel pads, may be beneficial in reducing pain and swelling, although the evidence is not conclusive 1, 2. However, the most recent and highest quality study on the topic, a 2020 Cochrane Review, found limited very low-certainty evidence to support the use of cooling treatments for relieving perineal pain after childbirth, and the results should be viewed with caution 1. Acetaminophen can be used for pain relief at 650-1000mg every 6 hours as needed, avoiding NSAIDs if there's concern for bleeding disorders. If bruising is extensive, unexplained, or accompanied by other symptoms like fatigue or easy bleeding, laboratory tests should be ordered including complete blood count, coagulation studies, and liver function tests. Patients with suspicious bruising patterns should also be assessed for potential abuse. Follow-up should be arranged if bruising doesn't resolve within 2-3 weeks or if new bruises continue to appear without explanation. It's also important to consider the potential risks and management of over-anticoagulation in patients on anticoagulant therapy, and the use of vitamin K to reverse excessive anticoagulation 3. Key considerations in the management of bruising include:
- Determining the cause of bruising and assessing for underlying medical conditions
- Providing supportive care, including rest, ice application, compression, and elevation of affected areas
- Using acetaminophen for pain relief, while avoiding NSAIDs if necessary
- Ordering laboratory tests if bruising is extensive or unexplained
- Assessing for potential abuse in patients with suspicious bruising patterns
- Arranging follow-up if bruising doesn't resolve or if new bruises appear without explanation.