What are the discharge instructions for a patient with a hematoma of the head?

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Discharge Instructions for Head Hematoma

Patients with head hematomas should be discharged with clear written and verbal instructions that emphasize monitoring for neurological deterioration, managing pain and swelling, and specific return precautions for emergency care. 1

Types of Head Hematomas and Their Significance

Head hematomas can be classified as:

  • Extradural/Epidural hematoma: Blood collection between skull and dura mater
  • Subdural hematoma: Blood collection between dura mater and brain surface
  • Intracerebral hemorrhage: Bleeding within brain tissue
  • Subgaleal/Scalp hematoma: Blood collection in soft tissues outside the skull

Discharge Instructions Components

1. Neurological Monitoring

  • Monitor for 24-48 hours: Have a responsible adult stay with the patient for at least 24 hours to observe for changes in condition 1
  • Waking checks: Wake patient every 2-3 hours during the first night to check responsiveness and orientation
  • Document baseline: Note current symptoms and level of alertness for comparison

2. Warning Signs Requiring Immediate Medical Attention

  • Decreased level of consciousness: Difficulty waking up, confusion, or disorientation 1
  • Worsening headache: Especially if severe or unrelieved by acetaminophen
  • Repeated vomiting: More than twice
  • Visual disturbances: Blurred or double vision
  • Seizures: Any seizure activity
  • Weakness or numbness: In any part of the body
  • Balance problems: Inability to walk normally
  • Neck stiffness: New onset of stiffness
  • Unusual behavior: Personality changes or irritability
  • Clear fluid from ears or nose: Possible cerebrospinal fluid leak
  • Increasing swelling: At the injury site 1

3. Pain Management and Swelling Reduction

  • Acetaminophen (Tylenol): Use for pain control; avoid NSAIDs for 24-48 hours due to bleeding risk
  • Cold therapy: Apply ice pack wrapped in cloth for 15-20 minutes every 1-2 hours for the first 24-48 hours
  • Head elevation: Keep head elevated on pillows while resting
  • Avoid manipulation: Do not press, massage, or manipulate the hematoma

4. Activity Restrictions

  • Rest: Limit physical activity for at least 24-48 hours
  • Gradual return: Resume normal activities slowly as symptoms improve
  • Avoid alcohol: For at least 48 hours after injury
  • No driving: Until cleared by healthcare provider
  • No contact sports: Until cleared by healthcare provider

5. Follow-up Care

  • Primary care follow-up: Schedule appointment within 1-2 weeks
  • Imaging follow-up: If applicable, schedule as recommended by provider
  • Return to ED: If any warning signs develop before scheduled follow-up

6. Special Considerations

For Patients on Anticoagulants/Antiplatelets

  • More vigilant monitoring: Higher risk of delayed bleeding
  • Medication management: Follow specific instructions regarding continuation or temporary cessation of these medications 1
  • Consider outpatient referral: For assessment of both fall risk and risk/benefit of anticoagulation therapy 1

For Elderly Patients

  • Extended monitoring: May require longer observation period
  • Fall prevention: Implement strategies to prevent future falls
  • More frequent follow-up: Consider earlier and more frequent check-ups

Important Caveats and Pitfalls

  1. Delayed hemorrhage risk: Some patients, particularly those on anticoagulants, may develop delayed intracranial bleeding even with initially normal CT scans 1, 2

  2. Discharge timing: Patients with head hematomas should only be discharged after:

    • Neurological examination has returned to baseline
    • Adequate pain control is achieved
    • Patient/caregiver demonstrates understanding of warning signs 1

  3. Written instructions: Always provide written discharge instructions in addition to verbal explanations, as studies show poor retention of verbal instructions alone 3

  4. Language and comprehension: Ensure instructions are provided in the patient's preferred language and at an appropriate literacy level

  5. Documentation: Clearly document that discharge instructions were provided and understood by the patient or caregiver

By following these comprehensive discharge instructions, patients with head hematomas can be safely managed at home while minimizing the risk of missed deterioration or complications.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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