Cold Compress for Hematomas
Apply a cold compress to a hematoma, not a warm compress. Cold therapy is the evidence-based first aid treatment for hematomas, reducing bleeding, pain, and swelling through vasoconstriction. 1
Immediate Cold Application Protocol
Cold therapy should be applied as soon as possible after hematoma formation using the following approach:
- Use an ice-water mixture in a plastic bag or damp cloth as this provides the most effective tissue cooling compared to ice alone or gel packs 1
- Apply for 20-30 minutes per application without direct skin contact to prevent cold injury 1
- Place a thin barrier (towel) between the cold pack and skin to avoid frostbite 1
- Limit applications to 10 minutes if 20 minutes is uncomfortable 1
- Repeat applications 3-4 times daily as needed for symptom control 1
Evidence Supporting Cold Over Heat
The superiority of cold therapy is demonstrated by:
- Cold compression reduces hematoma size by approximately 20 cm² over 3 hours compared to only 10 cm² with compression alone in post-cardiac catheterization patients 1, 2
- Cold therapy decreases total blood loss by 610 mL and extravasation by 357 mL compared to no cold therapy 1
- Heat application is explicitly not recommended as a first aid measure for hematomas or joint injuries, as it is inferior to cold application 1
Combined Treatment Approach
Add compression after or during cold application for optimal results:
- Apply direct pressure or a compression wrap to the hematoma site 1
- Ensure compression does not compromise circulation by checking that you can slip a finger under the bandage 1
- Elevate the extremity if feasible, though evidence for this is limited 1
Critical Timing Consideration
Cold therapy is specifically for the acute phase (first 6-12 hours after injury):
- The primary mechanism is vasoconstriction, which limits ongoing bleeding and hematoma expansion 3
- Cold application is intended for relatively small, limited-size injuries and should not cause systemic hypothermia, even in pediatric patients 1
When to Seek Emergency Care
Activate emergency services immediately if the hematoma is associated with:
- Expanding hematoma near major vessels (may indicate arterial injury) 4
- Blue or extremely pale extremity distal to the hematoma 1
- Loss of pulses or compromised perfusion 4
- Signs of compartment syndrome or severe tissue pressure 5
Common Pitfalls to Avoid
- Never apply ice directly to skin without a barrier, as this causes cold injury 1
- Do not use heat in the acute phase, as it increases bleeding and swelling 1, 3
- Avoid removing initial dressings prematurely to check bleeding, as this disrupts clot formation 4
- Do not apply cold for longer than 30 minutes continuously to prevent tissue damage 1