Tuesday, May 7, 2013

Series Post: Ask Dr. Dina - Bruises

DISCLAIMER: I am not a doctor, nor do I play one on TV. I do not hold a current medical license or certification (I let them lapse because I no longer work in the medical field and don't intend to ever again). What I do have is an extensive medical background in various fields. Everything you read here is the result of either education, training, research and interpretation, or personal experience. The information in this post is not to be taken as a substitute for professional medical advice or examination. Seriously, if you're having an immediate medical problem and you're reading this blog for help, get off the damned computer and call an ambulance! 

Today we continue my "Ask Dr. Dina" series with a post about more kinds of soft tissue injuries with a post about bruises. I was going to add cuts and scrapes in this post, but there's enough about bruising that cuts and scrapes are going to need their own entry, lest this turn into a medical lecture, and I'm not a substitute for your med school classes. Onward!

We've all had bruises. Anything with skin or soft flesh gets them (you've seen bruised apples at the store). A bruise is a common way of identifying bleeding under the skin. You bleed under the skin, it makes a spot. That spot can be all sorts of colors, and the color will change as the bruise either heals or worsens (depending on circumstance and location).

Bruises have all sorts of medical names, but the most common are "contusion" and "hematoma." They all mean the same thing - "bleeding (hemorrhaging) outside the vessels" - but the different terms indicate the varying degrees of the bleed (from now on referred to in proper medical context as "hemorrhage." I know. You hear "hemorrhage," you think "OMG bleeding to death!" No. "Hemorrhage" just means "bleeding," in any amount. It's the severity that's the important thing. "Hemorrhage" is colloquially accepted to mean "severe," but it's not technically correct. *The More You Know star*).

Let's start with your regular, run-of-the-mill, "I bumped my leg on the corner of the coffee table" bruise. Contusions are generally caused by trauma, but something as simple as kneeling down on the asphalt to pick up your dropped car keys can give you a contusion. All this means is you've broken some blood vessels and they've hemorrhaged their contents beneath your skin.

Sometimes these contusions hurt, sometimes they don't. Sometimes you don't even notice them until they're a pretty purple color hours later, or a funky green spot days after you bumped the coffee table. Either way, you've hemorrhaged under your skin, either a lot or a little, and it's made that spot because it takes awhile for the blood under there to be removed by your body's clean-up crew (your immune system).

Now, you can also bruise muscles (but the same still applies – it just means you've broken the blood vessels in the muscle and hemorrhaged) and bone. Yes, you can bruise your bones. Your bones have blood vessels running through them just like every other part of your body. These types of injuries usually involve intense pressure/crushing, like car accidents and so on.

The type of blood vessel that's hemorrhaging indicates the severity of the contusion. The tiniest vessels are called "capillaries," the next largest ones are referred to as "veins." ("Arteries," while also blood vessels, have a different job, and while it is technically possible to bruise an artery, it takes a hell of a lot more than just banging into a coffee table to do this, so we're not going to talk about arteries for the purposes of this post.)

While most contusions are benign, some can lead to complications, such as subdural hematomas, or "hemorrhaging under the dura." The dura is the little sac that encloses that squishy organ we like to call YOUR BRAIN, and there's not a whole lot of room in your skull for things that aren't where they should be. Hemorrhaging around your brain isn't a good thing and can kill you if it's not properly taken care of.

When you fracture a bone, you're going to have bruising around the injury. The severity depends on the break, but it's an injury, there's bleeding (hemorrhaging), there's a contusion. Contusions are what are called "closed" injuries (under the skin – not open wounds or broken skin; we'll talk more about these when we talk about cuts and scrapes), and generally stay beneath the tissue they're affecting.

Hematomas are a little different than your basic bruise. A hematoma is still a hemorrhage under the skin, but instead of diffusing into the surrounding tissue making it turn pretty-but-flat colors, it collects in an area and makes kind of a pouch. Hematomas are kind of little blood-filled sacs, and they're generally fairly large. Muscles are affected by hematomas more than skin, because your skin is good at letting the leak (hemorrhage) spread out. Muscles not so much. Hematomas are often called "deep bruises" for that reason. Sometimes you can see them under the skin (they look something like an egg under the skin – you know, like a "goose egg" on your head when you whack it hard? Yeah, that.), sometimes you can't.

What does all this have to do with your writing? Well, if you have to ask, you're doing it wrong. When was the last time your character sported a bruise? Had a black eye from a fist fight? (Hint: "black eyes" are generally hematomas – the blood collects underneath and around the eye socket and that's why they look shiny/puffy.) It's not much to have your character notice a bruise, or have it noticed by another. Also, if you're going to beat up your character, remember there are consequences.

If you're going to have your character break anything, remember there's going to be bruising from the trauma.

Join us next time when we talk about cuts and scrapes!

Questions about medical issues with your writing? Leave them in the comments below and I'll get back to you as soon as I can. (THESE MUST APPLY TO FICTIONAL SITUATIONS ONLY. I AM NOT YOUR DOCTOR, NOR A SUBSTITUTE FOR ONE.)

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