First aid for internal bleeding

Blood is an incredibly important component of our body. To keep the body functioning, and to keep the organs supplied with oxygen, the body must have enough circulating blood volume. Blood consists of red blood cells (erythrocytes), which convey oxygen throughout the body; white blood cells (leucocytes), which fight introduced infection; platelets, which assist in the clotting process; and plasma, the fluid portion of blood. Green first aid logo

Blood is moved around the body under pressure by the heart and blood vessels. Without an adequate blood volume and pressure, the human body soon collapses. Bleeding, or haemorrhage, poses a threat by causing both the volume and the pressure of the blood within the body to decrease through blood loss. Without adequate circulating blood, the body cannot receive a constant supply of oxygen and nutrients and so organs become damaged.

Bleeding is one of the most common causes of death in accidents. There are two types of bleeding: external bleeding which is obvious and apparent; and internal bleeding where the bleeding is not apparent at the outset but may show itself later in the form of bleeding from the nose, ear, lungs or stomach.

Internal bleeding

Internal bleeding is classified as either visible, in that the bleeding can be seen, or concealed, where no direct evidence of bleeding is obvious. Internal bleeding is always to be considered as a very serious matter, and urgent medical aid is necessary.

In most instances, obtaining an adequate history of the incident or illness will give the first aider the necessary clue as to whether internal bleeding may be present.

Remember that current signs and symptoms, or the lack of them, do not necessarily indicate the casualty’s condition. Certain critical signs and symptoms may not appear until well after the incident due to the stealth of the bleed, and may only be detected by the fact that the casualty’s observations worsen despite there being no obvious cause.

Visible internal bleeding

Visible internal bleeding can vary in appearance depending on the site of the bleed:

Lungs – frothy, bright red blood coughed up by the casualty

Stomach – dark ‘coffee grounds’, or red blood, in vomitus

Intestine/Bowel – dark, loose, foul smelling stools

Urinary Tract – dark or red coloured urine

Ears – bright, sticky blood or blood mixed with clear fluid

Bruising – the tissues look dark due to the blood under the skin. Caused by blows from blunt instruments or by crushing.

Concealed internal bleeding

In these cases, the first aider is heavily reliant on history, signs and symptoms. Judgement and experience play a part, but it may come down to a first aiders ‘gut feeling’. If you are unsure, assume the worst and treat for internal bleeding.

The detection of internal bleeding relies upon good observations and an appreciation of the physical forces that have affected the casualty. Remember to look at the important observations that may indicate internal bleeding, which include:

  • Skin appearance
  • Level of consciousness (See our guide on AVPU and GCS)
  • Pulse rate
  • Respiratory rate

Signs and Symptoms of internal bleeding

These signs and symptoms are similar to the signs and symptoms for shock

  • pale, cool, clammy skin
  • thirst
  • rapid, weak pulse
  • rapid, shallow breathing
  • ‘guarding’ of the abdomen
  • pain
  • nausea and vomiting
  • visible swelling (‘distension’) of the abdomen
  • gradually lapsing into shock

First aid for internal bleeding

  1. Call for emergency medical help
  2. Perform a primary survey
  3. If conscious -> treat for shock
  4. If unconscious -> recovery position
  5. Treat any injuries found
  6. Provide reassurance

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