Hemorrhage refers to the leakage of blood from the vessels. Depending on the component involved, we can speak of arterial, venous, mixed and capillary hemorrhage.
Types of Hemorrhage
- Arterial hemorrhage: the blood, bright red in colour, comes out in the form of a more or less intense jet and synchronous with the heartbeat; the surrounding skin often remains clean. If the rupture affects a large caliber arterial vessel, such as the femoral artery in the inguinal tract, the distance covered by the jet can reach a few metres.
- Venous hemorrhage: the blood, dark red in colour, flows continuously from the edges of the wound, like water from an overfilled glass; the edges and surrounding skin appear dirty with blood.
- Mixed hemorrhage: the lesion affects both venous and arterial vessels; the blood comes out without jets but in greater quantity and more quickly than in venous hemorrhages.
- Capillary hemorrhage: the blood, bright red in color, comes out in a slow but continuous flow.
Internal and External Hemorrhages
Based on their location, hemorrhages are divided into external, internal and externalized internal.
- External hemorrhages: the blood escapes outside the body following a trauma that has damaged the skin and underlying structures.
- Internal hemorrhages: the blood leaking from the vessels does not reach the outside but remains inside the body, collecting in natural cavities (intracavitary hemorrhages) or in the thickness of the tissues surrounding the lesion (interstitial hemorrhages). This category includes both small subcutaneous blood losses of traumatic origin and serious hemorrhages due to rupture of blood vessels in the chest, abdomen or skull.
- Externalized internal bleeding: the blood released from the vessels reaches the outside through natural orifices (nose, mouth, anus, vagina, ear canal, urethral orifice).
Unlike external haemorrhages, which allow the quantity of blood lost and the affected anatomical component to be assessed, internal haemorrhages are difficult to recognise; for this reason the diagnosis is based above all on the observation of the symptoms due to the state of acute anemia. The presence of internal hemorrhage should be suspected whenever penetrating wounds are observed in the skull, trunk or abdomen; blood or blood-containing fluids in the ears or nose; vomiting or coughing up blood; hematomas on the chest, abdomen, neck and limbs; blood in the urine or vaginal or rectal bleeding; fracture of the pelvic bones; paleness, sweating, increased heart rate and altered consciousness.
Based on their cause, they are divided into traumatic and spontaneous hemorrhages.
- Traumatic hemorrhages: due to wounds or bruises resulting in rupture of deep organs. They can be both internal and external (most frequently external).
- Spontaneous hemorrhages or pathological: they appear apparently for no reason or following minor trauma; their appearance is due to a pre-existing pathological condition that weakens or breaks a vessel (aneurysm, tumors, varicose veins, atherosclerosis, etc.) or due to a coagulation defect (hemophilia). They can be both internal and external (most frequently internal).
Based on location:
hemorrhages are usually named after the organ or anatomical area affected (abdominal, gastric, cerebral, cardiac, vaginal hemorrhage etc.); other times they take on particular names (epistaxis = nosebleed; rectorrhagia or proctorrhagia = bleeding from the rectum).
What to do – First aid
How to Cope with a Bleeding
In an adult human organism the total amount of circulating blood is equal to approximately 8% of body weight, for a total of approximately 5 – 6 litres. The sudden and rapid reduction in blood volume is responsible for the characteristic signs of hemorrhage.
If the blood loss is significant, hypovolemic or hemorrhagic shock occurs; this condition, which can arise with losses of 3/4 of a liter and become lethal with haemorrhages of 1.5 – 2 litres, is characterized by tachycardia (i.e. an increase in heart rate) or bradycardia (when the situation is very compromised); it is also accompanied by paleness, sweating, hypothermia, hypotension, rapid and frequent breathing, thirst, dyspnea and syncope. If the patient is not helped immediately, the blood pressure drops further, the skin takes on a bluish color (cyanosis) and death occurs.
While waiting for the emergency services, it is therefore essential to put into practice the first aid rules, which will differ based on the type and extent of the bleeding.
In case of external bleeding
Free the injured part from clothing; with sterile gauze or clean tissue, compress the bleeding point upstream (i.e. in an area chosen along the path of the artery between the heart and the wound) if it is an arterial vessel, downstream (i.e. after the lesion towards the body extremities) if it is a venous haemorrhage.
When the blood loss is abundant, it is necessary to bandage the wound with a certain pressure (greater in the presence of arterial hemorrhage, less when it is of venous origin); tourniquets should only be applied in the case of amputations and for short periods.
If the bleeding is from a wound and affects a limb, when there is no suspicion of a fracture, raise it higher than the body. If the bleeding is venous and compression of the wound is prevented by the presence of foreign bodies (such as splinters of glass or wood) this simple measure allows you to significantly reduce bleeding.
If the bleeding affects the head, the patient must be kept in a lying position.
Once applied, avoid removing the compression bandage, even if soaked in blood, in the following two hours (in order to allow the natural closure of the vessels and to prevent the loss of pressure exerted by the bandage from facilitating the escape of blood from the lesion) .
Direct compression and lifting of the limb are contraindicated in case of suspected fracture or dislocation, in probable spinal cord injury and in the presence of foreign bodies (which must never be removed to prevent them from causing further damage to adjacent structures). In similar situations it is possible to attempt remote compression on the points where the main artery that carries blood to the injured area runs on the surface and directly above a bone (site where the arterial pulse is felt). In this way the artery is crushed against the underlying hard formations and the arterial blood flow decreases.
The tourniquet can only be used when all previous methods have not stopped the bleeding, in amputations, in trauma from prolonged crushing of the limbs (over 7-8 hours) and in major emergencies. Made of soft, wide-band material (5-7 cm), the tourniquet should be positioned at the root of the limb and loosened every 20-30 minutes; this is because if it is kept too tight and/or for too long, it can cause even irreparable damage to the nervous and vascular structures. For the same reason it is necessary to note the time of application and make a mark (an L) on the patient’s forehead in order to signal its presence even when it is covered during transport to hospital. Venous hemorrhages, even if of considerable size, never justify the use of a tourniquet.
Pay attention to the signs of collapse that often occur in the case of significant bleeding (paleness, dizziness, cold sweats). In this case the subject must be placed in an anti-shock position (supine, with the head down and limbs raised) and covered with a light cloth.
In case of internal bleeding
If internal bleeding is suspected, keep the patient at rest in a lying position; alert medical help immediately and do not administer anything by mouth. In the presence of otorrhagia following head trauma (blood leakage from the ear canal), the bleeding must not be hindered and the subject must be placed in a safe position on the side of the haemorrhage. The same goes for epistaxis following head trauma. However, if the bleeding from the blood vessels present in the nasal cavities does not follow head trauma, the victim must be placed in a sitting position with the head slightly bent forward, loosen the clothes around the neck and compress the bleeding nostril with a finger for a few minutes; if possible, cooling the root of the nose with ice or cold water is useful; it is also important, once the bleeding has stopped, to avoid blowing or rubbing your nose.