Open injury bleeding

Alternative names
Blood loss; Bleeding

Definition
This condition involves losing blood. This can occur internally (when blood leaks from blood vessels inside the body), externally through a natural opening (such as the vagina, mouth, or rectum), or externally through a break in the skin.

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

Blood loss can cause bruises, 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.

Serious injuries don’t always bleed heavily, and some relatively minor injuries (for example, scalp wounds) can bleed profusely. People who take blood-thinning medication or who have a bleeding disorder, such as hemophilia, may bleed excessively and quickly because their blood cannot clot properly. Bleeding in such people requires immediate medical attention.

Always wash your hands before (if possible) and after giving first aid to someone who is bleeding to avoid infections. Try to use latex gloves when treating a bleeding victim. Latex gloves should be in every first aid kit.

People allergic to latex can use a non-latex, synthetic glove. Viral hepatitis can be transmitted by skin contact with infected blood, and HIV can be contracted 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 wounds can be very serious because of the possibility of severe internal bleeding, which may not be obvious from looking at a person, but which may result in shock.

Seek medical care immediately for any penetrating abdominal wound. If organs are showing through the wound, do not try to push them back into the abdomen unless they slide back in without your assistance. Cover the injury with a moistened cloth or bandage, and do not apply more than very gentle pressure to stop the bleeding.

Always seek emergency assistance if internal bleeding is suspected. This can rapidly become life-threatening. Immediate medical intervention may be needed. This can range from medications and intravenous fluids, to use of an internal scope (endoscope), to surgery.

Seek emergency assistance for severe bleeding, loss of a body part, or any serious Head injury.

Causes

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

Symptoms

     
  • Blood coming from an open wound  
  • Bruising  
  • Shock  
  • Paleness  
  • Clammy skin  
  • Dizziness or light-headedness after an injury  
  • Rapid pulse, increased heart rate  
  • Low blood pressure  
  • Shortness of breath  
  • Confusion or decreasing alertness  
  • Weakness

Internal: any of the above, plus:

     
  • Abdominal pain  
  • Swollen abdomen  
  • Signs of shock (see above)  
  • External bleeding through a natural opening       o Blood in the stool (appears black, maroon, or bright red)       o Blood in the urine (appears red, pink, or tea-colored)       o Vaginal bleeding (heavier than usual or after menopause)       o Blood in the vomit (looks bright red, or brown like coffee-grounds)

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 victim. 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 victim down. This will reduce the chances of fainting by increasing the blood flow to the brain. When possible, elevate the bleeding area.
  4. Remove any obvious loose debris or dirt from a wound. If an object such as a knife, stick, or arrow becomes embedded in the body, DO NOT remove it. Doing so may cause more damage to the victim and may increase the amount of bleeding. The object also might be embedded in an artery or organ. Place pads and bandages around the object and tape the object in place.
  5. Put pressure directly on an external 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, bind the wound dressing with adhesive tape or a piece of clean clothing. A cold pack should be applied 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. Immobilize the injured body part. Lay the victim flat, raise the feet about 12 inches, and cover the victim with a coat or blanket. However, do not place the victim in this position if there has been a head, neck, back, or leg injury or if the position makes the victim uncomfortable. 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. A tourniquet can be used if there is torrential bleeding and if continuous pressure isn’t stopping the bleeding. A tourniquet should be applied to the limb between the bleeding site and the heart. The tourniquet should be tightened to the point where the 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 probe a wound or pull out any embedded object from a wound. This will usually cause more bleeding and harm.  
  • DO NOT try to clean a large wound. This can cause heavier bleeding.  
  • DO NOT remove a dressing if it becomes soaked with blood. Instead, add a new one on top.  
  • 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 try to clean a wound after you get the bleeding under control. Get medical help.

Call immediately for emergency medical assistance if

     
  • The bleeding can’t be controlled, or is associated with a serious injury.  
  • The wound might need stitches, or if embedded gravel or dirt cannot be removed easily with gentle cleaning.  
  • Internal bleeding or shock is suspected.  
  • Signs of infection develop including increased pain, redness, swelling, discharge, swollen lymph nodes, fever, or red streaks spreading from the site toward the heart. (This is usually treated with topical or oral antibiotics. If untreated, an infection can cause a skin abscess or other complications.)  
  • If the injury involves an animal or human bite.  
  • If you are not up-to-date on tetanus immunization (within 5-10 years).

Prevention

     
  • Use good judgment and keep knives and sharp objects away from small children.  
  • Stay up-to-date on vaccinations. Generally, the tetanus immunization (vaccine) is renewed every 10 years. The victim should get a tetanus shot at 5 years if the person has had two or fewer prior immunizations; the wound is heavily contaminated (foreign material); or there is extensive crush injury or devitalized tissue.

 

Johns Hopkins patient information

Last revised: December 4, 2012
by Harutyun Medina, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.