What are the discharge instructions for a 68-year-old male with a hematoma to his left lower extremity from the emergency department (ED)?

Discharge Instructions for a 68-Year-Old Male with Lower Extremity Hematoma

A hematoma in the lower extremity should be managed with limb elevation, cold compresses, pain management, and careful monitoring for complications, with clear instructions on when to return to the emergency department.

Initial Management Instructions

Limb Elevation

• Elevate the affected leg above the level of the heart when sitting or lying down 1
• Maintain elevation as much as possible for the first 48-72 hours to reduce swelling and pain
• Use pillows to support the leg while elevated
• Avoid prolonged periods with the leg in a dependent position

Cold Application

• Apply cold compresses or ice packs to the affected area for 15-20 minutes at a time
• Wrap ice in a thin towel (never apply ice directly to skin)
• Repeat cold application 3-4 times daily for the first 48 hours

Activity Restrictions

• Avoid weight-bearing activities that cause pain
• Limit walking and standing for prolonged periods
• Avoid activities that could lead to further trauma to the affected area
• Gradually increase activity as pain and swelling improve

Pain Management

• Take over-the-counter pain medications as directed:
  • Acetaminophen (Tylenol) 650-1000 mg every 6 hours as needed
  • If not contraindicated, NSAIDs such as ibuprofen 400-600 mg every 6 hours with food

Monitoring Instructions

Signs Requiring Immediate Medical Attention

• Increasing pain not relieved by prescribed pain medications 2
• Significant increase in swelling or tension in the affected area
• Numbness, tingling, or inability to move the extremity below the hematoma
• Signs of skin necrosis (darkening or blackening of the skin over the hematoma)
• Fever above 100.4°F (38°C)
• Warmth, redness, or streaking extending from the hematoma site

Hematoma Evaluation

• Monitor the size of the hematoma daily
• Mark the borders of the visible bruising with a pen to track any expansion
• Take photos of the affected area daily if possible to track changes

Wound Care (If Applicable)

• Keep any dressings clean and dry
• Change dressings as instructed by your healthcare provider
• Do not remove any pressure dressings that were applied in the ED
• Do not puncture or attempt to drain the hematoma at home 1

Medication Considerations

• If you are on blood thinners (anticoagulants), follow specific instructions provided regarding continuation or temporary discontinuation
• Avoid aspirin unless specifically instructed otherwise by your physician
• If you have been prescribed antibiotics, take the full course as directed

Follow-up Care

• Schedule a follow-up appointment with your primary care physician within 3-7 days
• If the hematoma was evacuated in the ED, follow up within 48-72 hours for wound check
• If you have underlying conditions like diabetes or peripheral vascular disease, earlier follow-up (within 48 hours) is recommended

Special Considerations for Older Adults

• Be particularly vigilant about fall prevention while mobility is compromised
• Consider using assistive devices (cane, walker) if balance is affected
• Ensure adequate hydration to maintain blood volume and circulation
• Monitor for medication interactions if starting new pain medications

When to Return to the Emergency Department

• If the hematoma appears to be expanding rapidly
• If you develop severe, uncontrolled pain
• If you notice increased tension or pressure in the affected limb
• If you develop signs of compartment syndrome: severe pain, pallor, pulselessness, paresthesia (numbness/tingling), or paralysis in the affected limb 1
• If you develop signs of infection: increasing redness, warmth, drainage, or fever

Remember that proper management of a hematoma is crucial to prevent complications such as skin necrosis or compartment syndrome. Following these discharge instructions carefully will help ensure optimal healing and recovery.