Internal bleeding

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This article is about the medical condition. For the death metal band, see
Internal Bleeding
.
Internal bleeding
Other namesInternal hemorrhage
Hemorrhagic shock, hypovolemic shock, exsanguination

Internal bleeding (also called internal haemorrhage) is a loss of blood from a

hemorrhagic shock or death if proper medical treatment is not received quickly.[2] Internal bleeding is a medical emergency and should be treated immediately by medical professionals.[2]

Signs and symptoms

Signs and symptoms of internal bleeding may vary based on location, presence of injury or trauma, and severity of bleeding. Common symptoms of blood loss may include:

  • Lightheadedness
  • Fatigue
  • Urinating less than usual
  • Confusion
  • Fast heart rate
  • Pale and/or cold skin
  • Thirst
  • Generalized weakness

Visible signs of internal bleeding include:

  • Blood in the urine
  • Dark black stools
  • Bright red stools
  • Bloody noses
  • Bruising
  • Throwing up blood

Of note, it is possible to have internal bleeding without any of the above symptoms, and pain may or may not be present. [3]

A patient may lose more than 30% of their blood volume before there are changes in their vital signs or level of consciousness.[4] This is called hemorrhagic or hypovolemic shock, which is a type of shock that occurs when there is not enough blood to reach organs in the body.[5]

Causes

Internal bleeding can be caused by a broad number of things. We can break these up into three large categories:

  • Trauma, or direct injury to blood vessels within the body cavity
  • Genetic and acquired conditions, along with various medications, that result in an increased bleeding risk
  • Other

Traumatic

The most common cause of death in trauma is bleeding.[6] Death from trauma accounts for 1.5 million of the 1.9 million deaths per year due to bleeding.[4]

There are two types of trauma: penetrating trauma and blunt trauma.[2]

Non-traumatic

A number of pathological conditions and diseases can lead to internal bleeding. These include:

Other

This stomach with Linitis plastica (Brinton's disease) can cause internal bleeding

Internal bleeding could be a result of complications following surgery or other medical procedures. Some medications may also increase a person's risk for bleeding, such as

antiplatelet drugs in the treatment of coronary artery disease.[10]

Diagnosis

Vital signs

Blood loss can be estimated based on heart rate, blood pressure, respiratory rate, and mental status.

hemorrhagic shock
.


Advanced trauma life support (ATLS) by the American College of Surgeons separates hemorrhagic shock into four categories.[12][4][13]

Classification of Hemorrhagic Shock[12][4][13]
Estimated blood loss Heart rate (per minute) Blood pressure Pulse pressure (mmHg) Respiratory rate (per minute) Other
Class I hemorrhage < 15% Normal or minimally elevated Normal Normal Normal
  • Slightly anxious
Class II hemorrhage 15 - 30% 100 - 120 Normal or minimally decreased
systolic blood pressure
 Narrowed 20 - 30
Class III hemorrhage 30 - 40% 120 - 140
Systolic blood pressure
< 90 mmHg or change in blood pressure > 20-30% from presentation 		Narrowed 30 - 40
  • Altered mental status (anxious, confused)
  • Decreased urine output
Class IV hemorrhage > 40% > 140
Systolic blood pressure
< 90 mmHg 		Narrowed (< 25 mmHg) >35
  • Significantly altered mental status (confused, lethargic)
  • Cool, clammy skin with delayed capillary refill
  • Significantly decreased or absent urine output

Assessing circulation occurs after assessing the patient's airway and breathing (ABC (medicine)).[5] If internal bleeding is suspected, a patient's circulatory system is assessed through palpation of pulses and doppler ultrasonography.[2]

Physical examination

It is important to examine the person for visible signs that may suggest the presence of internal bleeding and/or the source of the bleed.[2] Some of these signs may include:

Imaging

If internal bleeding is suspected a

FAST exam may be performed to look for bleeding in the abdomen.[2][12]

If the patient has stable vital signs, they may undergo diagnostic imaging such as a CT scan.[4] If the patient has unstable vital signs, they may not undergo diagnostic imaging and instead may receive immediate medical or surgical treatment.[4]

Treatment

Management of internal bleeding depends on the cause and severity of the bleed. Internal bleeding is a medical emergency and should be treated immediately by medical professionals.[2]

Fluid replacement

If a patient has low blood pressure (

massive transfusion protocol.[12] The massive transfusion protocol replaces red blood cells, plasma, and platelets in varying ratios based on the cause of the bleeding (traumatic vs. non-traumatic).[4]

Stopping the bleeding

It is crucial to stop the internal bleeding immediately (achieve hemostasis) after identifying its cause.[4] The longer it takes to achieve hemostasis in people with traumatic causes (e.g. pelvic fracture) and non-traumatic causes (e.g. gastrointestinal bleeding, ruptured abdominal aortic aneurysm), the higher the death rate is.[4]

Unlike with external bleeding, most internal bleeding cannot be controlled by applying pressure to the site of injury.

REBOA has also been used for non-traumatic causes of internal bleeding, including bleeding during childbirth and gastrointestinal bleeding.[4]

Internal bleeding from a bone fracture in the arms or legs may be partially controlled with direct pressure using a tourniquet.[12] After tourniquet placement, the patient may need immediate surgery to find the bleeding blood vessel.[4]

Internal bleeding where the torso meets the extremities ("junctional sites" such as the

hemostatic dressing) should be applied.[4]

A campaign is to improve the care of the bleeding known as Stop The Bleed campaign is also taking place.[20]

References

  1. ^ Auerback, Paul. Field Guide to Wilderness Medicine (PDF) (12 ed.). pp. 129–131. Retrieved 13 March 2019.
  2. ^
    ISBN 978-0071701075
    .
  3. ^ "DynaMed". www.dynamed.com. Retrieved 2023-10-08.
  4. ^
    S2CID 205117992
    .
  5. ^
    ISBN 978-1292-17084-8
    .
  6. PMID 18212658
    .
  7. doi:10.1016/j.mporth.2009.12.003
    .
  8. PMID 16015555
    .
  9. ISBN 9780123739445
    .
  10. doi:10.1016/j.crvasa.2013.02.004
    .
  11. ISBN 978-0071701075
    .
  12. ^ a b c d e f g Colwell, Christopher. "Initial management of moderate to severe hemorrhage in the adult trauma patient". UpToDate. Retrieved 5 March 2019.
  13. ^
    ISBN 978-78-0-9968267
    .
  14. ^ Croushorn J. Abdominal Aortic and Junctional Tourniquet controls hemor-rhage from a gunshot wound of the left groin.JSpecOperMed.2014;14(2):6–8.
  15. ^ Croushorn J, Thomas G, McCord SR. Abdominal aortic tourniquet controlsjunctional hemorrhage from a gunshot wound of the axilla.J Spec Oper Med.2013;13(3):1–4.
  16. ^ Rall JM, Ross JD, Clemens MS, Cox JM, Buckley TA, Morrison JJ. Hemo-dynamic effects of the Abdominal Aortic and Junctional Tourniquet in ahemorrhagic swine model.JSurgRes. 2017;212:159–166.
  17. ^ Kheirabadi BS, Terrazas IB, Miranda N, Voelker AN, Grimm R, Kragh JF Jr,Dubick MA. Physiological Consequences of Abdominal Aortic and Junc-tional Tourniquet (AAJT) application to control hemorrhage in a swinemodel.Shock (Augusta, Ga). 2016;46(3 Suppl 1):160–166.
  18. ^ Taylor DM, Coleman M, Parker PJ. The evaluation of an abdominal aortictourniquet for the control of pelvic and lower limb hemorrhage.Mil Med.2013;178(11):1196–1201.
  19. doi:10.1097/TA.0000000000002013
  20. ^ Pons, MD, Peter. "Stop the Bleed - SAVE A LIFE: What Everyone Should Know to Stop Bleeding After an Injury".

External links

The Wikibook First Aid has a page on the topic of: Internal Bleeding
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