Bleeding

Answer 1

Definition

Bleeding refers to the loss of blood. Bleeding can happen inside the body (internally) or outside the body (externally). It may occur:

• Inside the body when blood leaks from blood vessels or organs
• Outside the body when blood flows through a natural opening (such as the vagina, mouth, or rectum)
• Outside the body when blood moves through a break in the skin

Alternative Names

Blood loss; Open injury bleeding

Considerations

Always seek emergency assistance for severe bleeding, and if internal bleeding is suspected. Internal bleeding can rapidly become life threatening, and immediate medical care is needed.

Serious injuries don't always bleed heavily, and some relatively minor injuries (for example, scalp wounds) can bleed quite a lot. People who take blood-thinning medication or who have a bleeding disordersuch as hemophiliamay bleed excessively and quickly because their blood does not clot properly. Bleeding in such people requires immediate medical attention.

Direct pressure will stop most external bleeding, and is the most important first aid step.

Always wash your hands before (if possible) and after giving first aid to someone who is bleeding, in order to avoid infection.

Try to use latex gloves when treating someone who is bleeding. Latex gloves should be in every first aid kit. People allergic to latex can use a non-latex, synthetic glove. You can catch viral hepatitis if you touch infected blood, and HIV can be spread if infected blood gets into an open wound -- even a small one.

Although puncture wounds usually don't bleed very much, they carry a high risk of infection. Seek medical care to prevent tetanus or other infection.

Abdominal and chest wounds can be very serious because of the possibility of severe internal bleeding. They may not look very serious, but can result in shock. Seek immediate medical care for any abdominal or chest wound. If organs are showing through the wound, do not try to push them back into place. Cover the injury with a moistened cloth or bandage, and apply only very gentle pressure to stop the bleeding.

Blood loss can cause bruises (blood collected under the skin), which usually result from a blow or a fall. They are dark, discolored areas on the skin. Apply a cool compress to the area as soon as possible to reduce swelling. Wrap the ice in a towel and place the towel over the injury. Do not place ice directly on the skin.

Causes

Bleeding can be caused by injuries or can occur spontaneously. Spontaneous bleeding is most commonly caused by problems with the joints or the gastrointestinal or urogenital tracts.

Symptoms

• Blood coming from an open wound
• Bruising
• Shock, which may cause any of the following symptoms:
  • Confusion or decreasing alertness
  • Clammy skin
  • Dizziness or light-headednessafter an injury
  • Low blood pressure
  • Paleness(pallor)
  • Rapid pulse, increased heart rate
  • Shortness of breath
  • Weakness

Symptoms of internal bleeding may also include:

• Abdominal pain
• Abdominal swelling
• Chest pain
• External bleeding through a natural opening
  • Blood in the stool (appears black, maroon, or bright red)
  • Blood in the urine (appears red, pink, or tea-colored)
  • Blood in the vomit (looks bright red, or brown like coffee-grounds)
  • Vaginal bleeding (heavier than usual or after menopause)

First Aid

First aid is appropriate for external bleeding. If bleeding is severe, or if shock or internal bleeding is suspected, get emergency help immediately.

1. Calm and reassure the person. The sight of blood can be very frightening.
2. If the wound is superficial, wash it with soap and warm water and pat dry. Superficial wounds or scrapes are injuries that affect the top layers of skin and bleeding from such wounds is often described as "oozing," because it is slow.
3. Lay the person down. This reduces the chances of fainting by increasing blood flow to the brain. When possible, raise up the part of the body that is bleeding.
4. Remove any obvious loose debris or dirt from a wound. If an object such as a knife, stick, or arrow becomes stuck in the body, DO NOT remove it. Doing so may cause more damage and may increase bleeding. Place pads and bandages around the object and tape the object in place.
5. Put pressure directly on an outer wound with a sterile bandage, clean cloth, or even a piece of clothing. If nothing else is available, use your hand. Direct pressure is best for outside bleeding, except for an eye injury.
6. Maintain pressure until the bleeding stops. When it has stopped, tightly wrap the wound dressing with adhesive tape or a piece of clean clothing. Place a cold pack over the dressing. Do not peek to see if the bleeding has stopped.
7. If bleeding continues and seeps through the material being held on the wound, do not remove it. Simply place another cloth over the first one. Be sure to seek medical attention.
8. If the bleeding is severe, get medical help and take steps to prevent shock. Keep the injured body part completely still. Lay the person flat, raise the feet about 12 inches, and cover the person with a coat or blanket. However, DO NOT move the person if there has been a head, neck, back, or leg injury, as doing so may make the injury worse. Get medical help as soon as possible.

Do Not

• DO NOT apply a tourniquet to control bleeding, except as a last resort. Doing so may cause more harm than good. A tourniquet should be used only in a life-threatening situation and should be applied by an experienced person
• If continuous pressure hasn't stopped the bleeding and bleeding is extremely severe, a tourniquet may be used until medical help arrives or bleeding is controllable.
  • It should be applied to the limb between the bleeding site and the heart and tightened so bleeding can be controlled by applying direct pressure over the wound.
  • To make a tourniquet, use bandages 2 to 4 inches wide and wrap them around the limb several times. Tie a half or square knot, leaving loose ends long enough to tie another knot. A stick or a stiff rod should be placed between the two knots. Twist the stick until the bandage is tight enough to stop the bleeding and then secure it in place.
  • Check the tourniquet every 10 to 15 minutes. If the bleeding becomes controllable, (manageable by applying direct pressure), release the tourniquet.
• DO NOT peek at a wound to see if the bleeding is stopping. The less a wound is disturbed, the more likely it is that you'll be able to control the bleeding
• DO NOT probe a wound or pull out any embedded object from a wound. This will usually cause more bleeding and harm
• DO NOT remove a dressing if it becomes soaked with blood. Instead, add a new one on top
• DO NOT try to clean a large wound. This can cause heavier bleeding
• DO NOT try to clean a wound after you get the bleeding under control. Get medical help

Call immediately for emergency medical assistance if

Seek medical help if:

• Bleeding can't be controlled, or is associated with a serious injury
• The wound might need stitches, or if gravel or dirt cannot be removed easily with gentle cleaning
• You think there may be internal bleeding or shock
• Signs of infection develop, including increased pain, redness, swelling, yellow or brown fluid, swollen lymph nodes, fever, or red streaks spreading from the site toward the heart
• The injury involves an animal or human bite
• The patient has not had a tetanus shot in the last 5-10 years

Prevention

Use good judgment and keep knives and sharp objects away from small children.

Stay up-to-date on vaccinations, especially the tetanus immunization.

ReferencesCornwell EE. Initial approach to trauma. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds.Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004: chap 251.

Answer 2

Definition

Bleeding refers to the loss of blood. Bleeding can happen inside the body (internally) or outside the body (externally). It may occur:

• Inside the body when blood leaks from blood vessels or organs
• Outside the body when blood flows through a natural opening (such as the vagina, mouth, or rectum)
• Outside the body when blood moves through a break in the skin

Alternative Names

Blood loss; Open injury bleeding

Considerations

Always seek emergency assistance for severe bleeding, and if internal bleeding is suspected. Internal bleeding can rapidly become life threatening, and immediate medical care is needed.

Serious injuries don't always bleed heavily, and some relatively minor injuries (for example, scalp wounds) can bleed quite a lot. People who take blood-thinning medication or who have a bleeding disordersuch as hemophiliamay bleed excessively and quickly because their blood does not clot properly. Bleeding in such people requires immediate medical attention.

Direct pressure will stop most external bleeding, and is the most important first aid step.

Always wash your hands before (if possible) and after giving first aid to someone who is bleeding, in order to avoid infection.

Try to use latex gloves when treating someone who is bleeding. Latex gloves should be in every first aid kit. People allergic to latex can use a non-latex, synthetic glove. You can catch viral hepatitis if you touch infected blood, and HIV can be spread if infected blood gets into an open wound -- even a small one.

Although puncture wounds usually don't bleed very much, they carry a high risk of infection. Seek medical care to prevent tetanus or other infection.

Abdominal and chest wounds can be very serious because of the possibility of severe internal bleeding. They may not look very serious, but can result in shock. Seek immediate medical care for any abdominal or chest wound. If organs are showing through the wound, do not try to push them back into place. Cover the injury with a moistened cloth or bandage, and apply only very gentle pressure to stop the bleeding.

Blood loss can cause bruises (blood collected under the skin), which usually result from a blow or a fall. They are dark, discolored areas on the skin. Apply a cool compress to the area as soon as possible to reduce swelling. Wrap the ice in a towel and place the towel over the injury. Do not place ice directly on the skin.

Causes

Bleeding can be caused by injuries or can occur spontaneously. Spontaneous bleeding is most commonly caused by problems with the joints or the gastrointestinal or urogenital tracts.

Symptoms

• Blood coming from an open wound
• Bruising
• Shock, which may cause any of the following symptoms:
  • Confusion or decreasing alertness
  • Clammy skin
  • Dizziness or light-headednessafter an injury
  • Low blood pressure
  • Paleness(pallor)
  • Rapid pulse, increased heart rate
  • Shortness of breath
  • Weakness

Symptoms of internal bleeding may also include:

• Abdominal painand swelling
• Chest pain
• External bleeding through a natural opening
  • Blood in the stool (appears black, maroon, or bright red)
  • Blood in the urine (appears red, pink, or tea-colored)
  • Blood in the vomit (looks bright red, or brown like coffee-grounds)
  • Vaginal bleeding (heavier than usual or after menopause)
• Skin color changes that occur several days after an injury (skin may black, blue, purple, yellowish green)

First Aid

First aid is appropriate for external bleeding. If bleeding is severe, or if shock or internal bleeding is suspected, get emergency help immediately.

1. Calm and reassure the person. The sight of blood can be very frightening.
2. If the wound is superficial, wash it with soap and warm water and pat dry. Superficial wounds or scrapes are injuries that affect the top layers of skin and bleeding from such wounds is often described as "oozing," because it is slow.
3. Lay the person down. This reduces the chances of fainting by increasing blood flow to the brain. When possible, raise up the part of the body that is bleeding.
4. Remove any obvious loose debris or dirt from a wound. If an object such as a knife, stick, or arrow becomes stuck in the body, DO NOT remove it. Doing so may cause more damage and may increase bleeding. Place pads and bandages around the object and tape the object in place.
5. Put pressure directly on an outer wound with a sterile bandage, clean cloth, or even a piece of clothing. If nothing else is available, use your hand. Direct pressure is best for external bleeding, except for an eye injury.
6. Maintain pressure until the bleeding stops. When it has stopped, tightly wrap the wound dressing with adhesive tape or a piece of clean clothing. Place a cold pack over the dressing. Do not peek to see if the bleeding has stopped.
7. If bleeding continues and seeps through the material being held on the wound, do not remove it. Simply place another cloth over the first one. Be sure to seek medical attention.
8. If the bleeding is severe, get medical help and take steps to prevent shock. Keep the injured body part completely still. Lay the person flat, raise the feet about 12 inches, and cover the person with a coat or blanket. DO NOT move the person if there has been a head, neck, back, or leg injury, as doing so may make the injury worse. Get medical help as soon as possible.

Do Not

• DO NOT apply a tourniquet to control bleeding, except as a last resort. Doing so may cause more harm than good. A tourniquet should be used only in a life-threatening situation and should be applied by an experienced person
• If continuous pressure hasn't stopped the bleeding and bleeding is extremely severe, a tourniquet may be used until medical help arrives or bleeding is controllable.
  • It should be applied to the limb between the bleeding site and the heart and tightened so bleeding can be controlled by applying direct pressure over the wound.
  • To make a tourniquet, use bandages 2 to 4 inches wide and wrap them around the limb several times. Tie a half or square knot, leaving loose ends long enough to tie another knot. A stick or a stiff rod should be placed between the two knots. Twist the stick until the bandage is tight enough to stop the bleeding and then secure it in place.
  • Check the tourniquet every 10 to 15 minutes. If the bleeding becomes controllable, (manageable by applying direct pressure), release the tourniquet.
• DO NOT peek at a wound to see if the bleeding is stopping. The less a wound is disturbed, the more likely it is that you'll be able to control the bleeding
• DO NOT probe a wound or pull out any embedded object from a wound. This will usually cause more bleeding and harm
• DO NOT remove a dressing if it becomes soaked with blood. Instead, add a new one on top
• DO NOT try to clean a large wound. This can cause heavier bleeding
• DO NOT try to clean a wound after you get the bleeding under control. Get medical help

Call immediately for emergency medical assistance if

Seek medical help if:

• Bleeding can't be controlled, required the use of a tourniquet, or was caused by a serious injury
• The wound might need stitches
• Gravel or dirt cannot be removed easily with gentle cleaning
• You think there may be internal bleeding or shock
• Signs of infection develop, including increased pain, redness, swelling, yellow or brown fluid, swollen lymph nodes, fever, or red streaks spreading from the site toward the heart
• The injury was due to an animal or human bite
• The patient has not had a tetanus shot in the last 5-10 years

Prevention

Use good judgment and keep knives and sharp objects away from small children.

Stay up-to-date on vaccinations, especially the tetanus immunization.

ReferencesCornwell EE. Initial approach to trauma. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds.Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004: chap 251. Reviewed By

Review Date: 02/11/2011

David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington.