Alternate Names: Blood loss; Open injury bleeding

Considerations:

Direct pressure will stop most external bleeding.

Bruises usually result from a blow or a fall. They are dark, discolored areas on the skin. Apply a cool compress to the area as soon as possible to reduce swelling. Do not put ice directly on the skin. Instead, wrap the ice in a towel and place the towel on or around the injury for 10 minutes.

The amount of blood is not a good way to judge the severity of an injury. Serious injuries don’t always bleed heavily, and some relatively minor injuries (for example, scalp wounds) bleed profusely. The blood of people who take blood-thinning medication or who have a bleeding disorder such as hemophilia may not clot easily.

Always wash your hands before (if possible) and after giving first aid to avoid the risk of infection and transmission of disease. Always try to use latex gloves when treating a bleeding victim to prevent the possibility of being exposed to an infectious disease. Always carry latex gloves in the first aid kit. People allergic to latex, can use an impermeable non-latex synthetic glove.

Although puncture wounds usually don’t bleed very much, they carry a high risk of infection. Seek medical care to prevent tetanus or other infection.

Abdominal wounds can be very serious because of the possibility of severe internal bleeding, which may not be obvious externally, but which may result in shock. Seek medical care immediately if internal bleeding is suspected. If organs have been displaced by the wound, do not try to push them back into the abdomen unless they slide back in without your assistance; cover the injury with a moistened cloth or bandage, and do not apply more than very gentle pressure to stop the bleeding.

Always seek emergency assistance if internal bleeding is suspected. This can rapidly become life-threatening. Immediate medical intervention may be needed to stop the bleeding; this can range from medications and intravenous fluids, to use of an internal scope (endoscope), to surgery.

Seek emergency assistance for severe bleeding, loss of a body part, or head injury if appropriate.

Causes: Damage to a blood vessel causes bleeding, which can range from minor to life-threatening.

Symptoms:

Internal:

• Abdominal pain
• Swollen abdomen
• Dizziness or lightheadedness after an injury
• External bleeding through a natural opening
• Signs of shock (see below)

External through a natural opening:

• Blood in the stool (can appear black or bright red)
• Blood in the urine
• Vaginal bleeding (heavier than usual or for a prolonged time)
• Blood in the vomit (looks bright red, or brown like coffee-grounds)

External:

• Blood coming from an open wound
• Bruising
• Shock
• Paleness
• Clammy skin
• Bluish lips and fingernails
• Decreasing alertness
• Rapid pulse, increased heart rate
• Low blood pressure
• Confusion
• Weakness

Do Not:

• Apply a tourniquet to control bleeding, except as a last resort; doing so may cause more harm than good. A tourniquet should be used only in a life-threatening situation and should be applied by an experienced person. A tourniquet can be used if there is torrential bleeding and if continuous pressure isn’t stopping the bleeding. A tourniquet should be applied to the limb between the bleeding site and the heart. The tourniquet should be tightened to the point where the bleeding can be controlled by applying direct pressure over the wound. To make a tourniquet, used bandages 2 to 4 inches wide and wrap them around the limb several times. Tie a half or square knot, leaving loose ends long enough to tie another knot. A stick or a stiff rod should be placed between the two knots. Twist the stick until the bandage is tight enough to stop the bleeding and then secure it in place. Check the tourniquet every 10 to 15 minutes. If the bleeding becomes controllable, (manageable by applying direct pressure), release the tourniquet.
• Probe a wound or pull out any embedded object from a wound. This will usually cause more bleeding and harm.
• Try to clean a large wound. This can cause heavier bleeding.
• Remove a dressing if it becomes soaked with blood. Instead, add a new one on top.
• Peek at a wound to see if the bleeding is stopping. The less a wound is disturbed, the more likely it is that you’ll be able to control the bleeding.
• Try to clean a wound after you get the bleeding under control. Get medical help.

Call If:

• The bleeding can’t be controlled or is associated with a serious injury.
• The wound might need stitches, or if embedded gravel or dirt cannot be removed easily with gently cleaning.
• Internal bleeding or shock is suspected.
• Signs of infection develop including increased pain, redness, swelling, discharge, swollen lymph nodes, fever, or red streaks spreading from the site toward the heart. (This is usually treated with topical or oral antibiotics; if untreated an infection can cause a skin abscess or other complications).

First Aid:

First aid is appropriate for external bleeding. If bleeding is severe, or if shock or internal bleeding is suspected, get emergency help immediately!

1. Calm and reassure the victim. The sight of blood can be very frightening.
   
2. Lay the victim down. This will reduce the chances of fainting by increasing the blood flow to the brain.
   
3. Remove any obvious loose debris or dirt from a wound. If an object such as a knife, stick, or arrow becomes embedded in the body, do not remove it. Doing so may cause more damage to the victim and may increase the amount of bleeding. The object also might be embedded in an artery or organ. Place pads and bandages around the object and tape the object in place.
   
4. Put pressure directly on an external wound with a sterile bandage, clean cloth, or even a piece of clothing. If nothing else is available, use your hand.
   
5. Direct pressure is usually best for external bleeding, except for an eye injury, on a wound that contains an embedded object, or on a head injury if there is a possibility of a fractured skull.
   
6. If the wound is superficial, wash it with soap and warm water and pat dry. Superficial wounds or scrapes are injuries that happen to the top layers of skin and bleeding are described as being of an oozing nature. A cut or deep wound is deeper. However, don’t wash a wound that is deep or bleeding profusely. When the bleeding has subsided, even if the wound is still oozing, place a clean dressing over the wound. Bandage the dressing firmly (dressings should be large enough to extend at least one inch beyond the edges of the wound), but not so tightly that the victim’s skin beyond the wound becomes pale and cool, which indicates that the circulation is being cut off.
   
7. Maintain pressure until the bleeding stops. When it has stopped, bind the wound dressing tightly with adhesive tape. If none is available, use a piece of clean clothing. A cold pack should be applied to the wound for 10 minutes. Direct pressure is necessary for 10 minutes to allow severed vessels to close and allow early blood clot formation. Do not peek to see if the bleeding has stopped. Keep the victim lying down and elevate the wound above the level of the heart.
   
8. If bleeding continues and seeps through the material being held on the wound, do not remove it. Simply place another cloth over the first one.
   
9. If the bleeding doesn’t stop after 15 minutes of direct pressure, or if the wound is too extensive to cover effectively, use pressure-point bleeding control. For example, in the case of a wound on the hand or lower arm, squeeze the main artery in the upper arm against the bone. Keep your fingers flat. With the other hand, continue to exert pressure on the wound itself.
   
10. If the bleeding is severe, get medical help and take steps to prevent shock. Immobilize the injured body part. Lay the victim flat, raise the feet about 12 inches, and cover the victim with a coat or blanket. However, do not place the victim in this position if there has been a head, neck, back, or leg injury or if the position makes the victim uncomfortable. Get medical help as soon as possible.

Prevention:

• Use good judgment and keep knives and sharp objects away from small children.
• Stay up-to-date on vaccinations. Generally, the tetanus immunization (vaccine) is renewed every 10 years. Immunization is indicated at 5 years if the person has had two or fewer prior immunizations; the wound is heavily contaminated (foreign material); or there is extensive crush injury or devitalized tissue.