Overview of hemorrhage
Hemorrhage is also called bleeding. Bleeding can be internal or external meaning blood loss inside or outside the body respectively.
Virtually any body part can bleed. When blood loss occurs from an injured vessel or organ, it is an internal bleed while an external bleed occurs when blood loss is through an opening in the skin.
Sometimes, blood loss from a tissue can be visible when it leaks from a natural orifice such as the mouth, nose, vagina, or rectum.
Causes of bleeding
Bleeding occurs commonly due to certain circumstances. The various conditions that can cause bleeding include:
An injury can lead to traumatic bleeding. The various conditions that can lead to traumatic bleeding include:
- Abrasions: they just skin bruises that do not extend far below the skin.
- Hematoma or bruises: hematoma is just a blood collection under a tissue.
- Penetrating wounds such as gunshot wounds, stab wounds
- Puncture wounds from items such as needles, nails or knives
Some medical conditions can cause bleeding though this is not as common as traumatic bleeding.
Example of medical conditions that can cause bleeding include:
- Leukemia meaning cancer of white blood cells
- Liver disease
- Heavy menstrual bleed called menorrhagia, seen in a medical condition such as endometriosis
- Von Willebrand disease
- Vitamin K deficiency
- Brain trauma
- Colon diverticulosis
- Lung cancer
- Acute bronchitis
Some medications increase the likelihood of bleeding while some others are known to even cause bleeding. Usually, when a doctor prescribes such medication, they will tell you about possible bleeding and what to do if the bleeding occurs.
Medications that can cause bleeding include:
- Blood thinners such as clopidogrel
- Prolonged use of antibiotics
- Aspirin and other non-steroidal anti-inflammatory drugs
Could hemorrhage be an emergency?
Bleeding could be an emergency. Life-threatening bleeding such as an internal bleed requires urgent intervention so do well to seek emergency help to stop the bleeding.
Seek emergency help when faced with any of the following:
- Bleeding is not controlled by pressure
- One goes into shock or has a fever alongside
- The wound needs a tourniquet
- The bleeding was caused by a severe injury
- The wound may need suturing to control bleeding
- Presence of foreign body in the wound
- An infected wound which is discharging pus, swollen or inflamed
- Wound resulting from a human or animal bite
In some cases, emergency response will ask you to lay the injured person down to reduce the likelihood of fainting, other times you may be told to keep putting pressure on the wound until the emergency team arrives.
Treatment of hemorrhage
Massive bleeding can cause death within 5 minutes. Eyewitnesses may be able to carry out first aid and save a life before the emergency team arrives.
In some mass casualties, people have died bleeding even when their wound wasn’t a fatal one, thus the need for a nationwide sensitization and tutelage on how to stop bleeding.
First aid for traumatic bleeding
External bleeding due to trauma can be treated. If the person has any of the emergency signs as earlier listed then you should seek help to stop the bleeding.
On the patient’s angle, he or she should try to remain calm as the speed of bleeding will be increased if heart rate and blood pressure are not controlled.
The likelihood of fainting is reduced if the person is laid down and also elevate the bleeding site to increase venous return to the heart.
Clean a wound by getting rid of foreign bodies and debris in the wound. Do not pull out large items such as knives, arrows or weapons. Leave these items in place because pulling them out can lead to massive blood loss which can kill the patient in minutes. In such cases, it is advisable to keep the object in place using pads and bandages which will further absorb the bleeding.
The following materials can be used to apply pressure to a bleeding wound:
- Clean cloth
- Gloved hands
Apply a medium amount of pressure until the bleeding slows and stops.
Do not do the following:
- Remove the cloth when the bleeding is less or stops. Rather use adhesive tape or other clothing to further hold it in place. Afterward, place a cold pack over the wound.
- Inspect the wound to see if the bleeding has stopped as this can further trigger the wound to bleed again.
- Remove the cloth if the bleeding seeps through instead, add more clothing on top and continue applying pressure.
- Move anyone who is injured on the head, back, neck, or leg.
- Apply pressure to an eye injury.
A tourniquet should only be used when other measures to stop blood loss have failed. A tourniquet should only be applied by skilled personnel with the following steps:
1. Location: it should be applied midway between the heart and the bleeding body part.
2. Bandages can be used to make the tourniquet. Wrap the bandages around the limb and tie a half knot. Ensure that the loose ends are enough to tie another half knot.
3. Between two knots, place a stick.
4. Tighten the bandage by twisting the stick.
5. Stabilize the tourniquet using a tape or cloth.
6. Check the tourniquet every 10 minutes to see if the blood loss has slowed enough to be controlled by the direct application of pressure. If so, release the tourniquet and apply pressure.
Signs of a medical emergency
Blood loss is said to be an emergency if:
- It is caused by a serious injury
- It cannot be controlled
- It is internal
Attempts to stop bleeding can begin at home, while on a stretcher, or even by the paramedics. The treatment depends on the cause of the bleeding.
Surgery may be needed to stop the bleeding in rare cases.
What happens if the hemorrhage is left untreated?
Unexplained or uncontrolled bleeding should be managed by a health professional.
When blood loss is due to an accident or injury, initial first aid can stop it and if it is a superficial wound, it will heal without needing further care.
Deeper wounds will require suturing, wound dressing, or corrective surgery.
If the cause of hemorrhage is a medication condition, it must be identified else it could recur.
Any bleeding that goes on without medical intervention could be life-threatening because resuscitation with the use of IV fluids and blood transfusion would not be administered.
Medical conditions that cause blood loss slowly when prolonged can also contribute to major organ failure, and eventually death.
Severe hemorrhage or bleeding to death without any obvious external bleeding can also occur and this is called exsanguination. It can be seen in conditions such as a ruptured vessel aneurysm.