Bleeding

What should we know?

A hemorrhage is defined as a loss of blood due to the rupture of blood vessels.

Hemorrhages can be internal or external and usually involve heavy bleeding in a short period of time.

When bleeding or hemorrhaging occurs after an injury, all necessary steps must be taken to stop the loss of blood.

If substantial amounts of blood are lost, loss of consciousness may occur, an extremely serious condition known as collapse or shock, and death may even result.

However, most bleeding injuries are not life-threatening, although appropriate care should be taken not only to stop the bleeding, but also to prevent infection and other complications.

What types of bleeding are there?

First of all, it is useful to distinguish the type of bleeding.

There are several ways to classify hemorrhages.

According to their cause:

• Traumatic: bleeding can occur from injuries caused by a sharp or pointed object, by a firearm projectile, or by blunt trauma such as being struck or involved in a car accident.
• Non-traumatic: blood vessels rupture due to a disease or spontaneously. Examples of these hemorrhages include gastrointestinal bleeding (vomiting blood, blood in the stool), aneurysm rupture, epistaxis (nosebleed), hemoptysis (blood in the sputum), and vaginal bleeding.

According to the injured blood vessel. There are three main types:

1. Capillary bleeding: Capillaries are the smallest blood vessels in the body and also the most numerous.
   
   When a minor cut opens a capillary, bleeding is usually very mild. Within a few minutes, the body's clotting system will work and stop the bleeding.
   
   
2. Venous bleeding: When bleeding comes from injured veins, the blood lost is on its way back to the heart and has already released its oxygen load to the cells, so the blood is dark red and flows slowly.
   
   Venous bleeding is initially stopped by applying local pressure.
   
   
3. Arterial bleeding: This is the least common but the most serious. Blood released from an artery is bright red and usually comes out forcefully, often in rhythmic spurts that coincide with the heart's contractions.
   
   If a bleeding injury to a major artery is not treated promptly, it is possible to bleed to death in less than a minute.
   
   In most cases, however, direct and firm pressure on the wound will stop arterial bleeding, although the process will always take longer than with venous bleeding.
   
   

In addition to the obvious flow of blood, other signs and symptoms that the person is suffering a hemorrhage, in many cases due to blood clotting problems, are:

• Petechiae (small, pinpoint red lesions on the skin)
• Purpura (purplish spots on the skin, 2.5 cm in diameter)
• Ecchymosis (larger spots on the skin)
• Hematomas (large accumulations of blood)
• Subconjunctival bleeding (a small accumulation of blood is seen on the sclera, that is, on the white part of the eye)
• Retinal bleeding (inner layer of the eye) with or without loss of vision)
• Blood blisters, especially in the mouth

What types of injuries can cause traumatic hemorrhage?

There are two types of injuries that frequently present with bleeding and should be taken into consideration.

Soft tissue injuries

Bleeding can occur from incised wounds (such as cuts and puncture wounds), abrasions (when the superficial layers of the skin are lost due to friction or scraping against a surface), or avulsions (when areas of skin are violently torn away).

A small cut that bleeds only slightly is treated solely by washing the wound with soap and water and applying a bandage to keep it clean.

Any more complicated wound requires consultation with your doctor or a visit to the Emergency Department.

Abdominal wounds

Given the presence of numerous vital internal organs, a wound that penetrates the abdominal wall requires immediate urgent care. Call the emergency telephone number or an ambulance immediately to transport the injured person.

Before moving someone with an abdominal wound, place them in the supine position, that is, lying on their back. If no internal organs are protruding through the wound, apply pressure with a sterile cloth over the bleeding wound to try to stop the hemorrhage.

If organs are already displaced through the wound, do not attempt to put them back in place. Cover the wound with a cloth and apply only very gentle pressure to stop the bleeding.

Abdominal trauma can also cause internal bleeding that is not visible, but may cause the person to rapidly lose consciousness and go into shock.