From the Research
For a large painless hematoma following a closed stab wound without signs of infection, treatment should focus on conservative management with the RICE protocol, as most hematomas resolve naturally without significant morbidity or mortality risk, as suggested by general medical principles and supported by the lack of strong evidence for aggressive intervention in such cases 1, 2. The RICE protocol involves:
- Resting the affected area to prevent further injury
- Applying Ice for 15-20 minutes every 2-3 hours for the first 48-72 hours to reduce swelling
- Using Compression with an elastic bandage to limit swelling
- Elevating the area above heart level when possible to reduce blood flow to the area Over-the-counter pain medications like acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) can help manage discomfort; avoid NSAIDs like ibuprofen initially as they may increase bleeding risk, as noted in general medical practice. The hematoma should gradually resolve over 1-3 weeks as the body reabsorbs the blood. Medical attention is necessary if the hematoma rapidly enlarges, becomes increasingly painful, restricts movement, or if signs of infection develop, as these could indicate a more serious condition requiring prompt intervention, such as infection or significant bleeding, as discussed in the context of trauma care 3, 4. For very large hematomas, especially those causing significant discomfort or functional impairment, medical evaluation may be needed to determine if drainage is appropriate, considering the potential benefits and risks, including the risk of infection or further bleeding, as illustrated by specific cases 5.