Bleeding

Bleeding, or hemorrhage, is the name used to describe blood loss. It can refer to blood loss inside the body, called internal bleeding. Or it can refer to blood loss outside of the body, called external bleeding.

Blood loss can occur in almost any area of the body. Internal bleeding occurs when blood leaks out through a damaged blood vessel or organ. External bleeding happens when blood exits through a break in the skin. Or it also happens when blood exits through a natural opening in the body, such as the:

• mouth
• vagina
• rectum
• nose

What are the common causes of bleeding?

Bleeding is a common symptom. A variety of incidents or conditions can cause bleeding. Possible causes include:

Traumatic bleeding

An injury can cause traumatic bleeding. Common types of traumatic injury include:

• abrasions or grazes that do not penetrate below the skin
• hematoma or bruises
• lacerations or incisions
• puncture wounds from items like needles or knives
• crushing injuries
• gunshot wounds

Medical conditions

There are also some medical conditions that can cause bleeding. Bleeding due to a medical condition is less common than traumatic bleeding. Conditions that can cause bleeding include:

• hemophilia
• leukemia
• liver disease
• menorrhagia, heavy or prolonged menstrual bleeding
• thrombocytopenia, low blood platelet count
• von Willebrand disease
• vitamin K deficiency
• brain trauma
• bowel obstruction
• congestive heart failure (CHF)
• lung cancer
• acute bronchitis
• severe hypothermia

Medicines

Some medicines can increase your chances of bleeding, or even cause bleeding. Your doctor will warn you about this when they first prescribe the medication. And they’ll tell you what to do if bleeding occurs.

Medications that may be responsible for bleeding include:

• blood-thinning medications
• antibiotics, when used on a long-term basis
• radiation therapy
• aspirin

Emergency issues

If bleeding is severe, call an ambulance immediately. You should seek emergency help if you suspect internal bleeding. This can become life-threatening.

People who have bleeding disorders or take blood thinners should also seek emergency help to stop bleeding.

Seek medical help if:

• the person has gone into shock or has a fever
• the bleeding cannot be controlled using pressure
• the wound requires a tourniquet
• the bleeding was caused by a serious injury
• the wound may need stitches to stop bleeding
• foreign objects are stuck inside the wound
• the wound appears to be becoming infected, such as swelling or leaking a yellow or brown fluid, or has redness
• the injury occurred due to a bite from an animal or human

When you call for help, emergency services will tell you what to do and when they’ll arrive. In most cases, emergency services will tell you to continue to put pressure on the wound. And to keep reassuring the patient. You may also be told to lay the person down to reduce their risk of fainting.

How is bleeding treated?

A person can bleed to death in five minutes. Bystanders may be able to save a life before emergency personnel can arrive.

There is a national campaign called Stop the Bleed to teach lay people how to stop bleeding. People in mass casualty events have died from blood loss even when their wounds should not have been fatal.

First aid for traumatic bleeding

It is possible to treat external traumatic bleeding. Seek emergency help if the patient is having any of the emergency issues listed above. And also if you need help to stop the bleeding.

The person who is bleeding should try to remain calm to keep their heart rate and blood pressure controlled. Either heart rate or blood pressure being too high will increase the speed of bleeding.

Lay the person down as soon as possible to reduce the risk of fainting. And try to elevate the area that is bleeding.

Remove loose debris and foreign particles from the wound. Leave large items such as knives, arrows, or weapons where they are. Removing these objects can cause further harm and will likely increase the bleeding. In this case, use bandages and pads to keep the object in place and absorb the bleeding.

Use the following to put pressure onto the wound:

• clean cloth
• bandage
• clothing
• your hands

Maintain a medium pressure until the bleeding has slowed and stops.

Do not remove the cloth when bleeding stops. Use an adhesive tape or clothing to wrap around the dressing and hold it in place. Then place a cold pack over the wound.

Do not look at the wound to see if bleeding has stopped. This can disturb the wound and cause it to begin bleeding again.

Do not remove the cloth from the wound, even if blood seeps through the material. Add more material on top, and continue the pressure.

Do not move anyone with an injury to the:

• head
• neck
• back
• leg

Do not apply pressure to an eye injury.

Use tourniquets only as a last resort. An experienced person should apply the tourniquet. To apply a tourniquet, follow these steps:

• Identify where to place the tourniquet. Apply it to a limb between the heart and the bleeding.
• Make the tourniquet using bandages, if possible. Wrap them around the limb, and tie a half knot. Ensure there is enough room to tie another knot with the loose ends.
• Place a stick or rod between the two knots.
• Twist the stick to tighten the bandage.
• Secure the tourniquet in place with tape or cloth.

Check the tourniquet every 10 minutes. If the bleeding slows enough to be controlled with pressure, release the tourniquet and apply direct pressure instead.

Medical care

You will need emergency medical care if:

• bleeding is caused by a serious injury
• bleeding cannot be controlled
• bleeding is internal

Paramedics will attempt to control the bleeding before rushing you to the hospital. In some cases, care might be given at home or by using a stretcher. The treatment required will depend on the cause of the bleeding.

In rare cases, surgery may be required to stop bleeding.

What are the consequences of untreated bleeding?

A medical professional should see anyone who experiences unexplained or uncontrolled bleeding.

Traumatic bleeding

If an injury or accident causes bleeding, it may be stopped with first aid. The wound will then heal without further care.

Medical bleeding

If a medical condition causes bleeding, and the condition is not identified or diagnosed, the bleeding is likely to recur.

Any bleeding that continues without medical treatment could be fatal. If someone loses between one-third and one-half of their total blood they could bleed to death. But bleeding to death is uncommon.

Exsanguination, or bleeding to death, can occur without any external bleeding. Catastrophic internal hemorrhages can cause a great deal of blood loss, as can aneurysms.