Definition and Types of Hemorrhage
Hemorrhage means the leakage of blood from the vessels. Depending on the component involved, one can speak of arterial, venous, mixed and capillary hemorrhage.
- Arterial hemorrhage : the blood, bright red, comes out in the form of a jet more or less intense and synchronous with the heart beats; often the surrounding skin remains clean. If the rupture involves a large-caliber arterial vessel, such as the femoral artery in the inguinal tract, the distance covered by the jet can reach a few meters.
- Venous hemorrhage : the blood, dark red in color, comes out continuously from the edges of the wound, like water from an overflow glass; the edges and surrounding skin appear to be stained with blood.
- Mixed hemorrhage : the lesion affects both venous and arterial vessels; the blood comes out without jets but in quantity and with greater speed than venous bleeding.
- Capillary hemorrhage : the blood, bright red, comes out with a slow but continuous flow.
Internal and External Hemorrhages
Depending on their location, bleeding can be distinguished in exterior, interior and exteriorized interiors.
- External bleeding: the blood exits the body following a trauma that has damaged the skin and underlying structures.
- Internal bleeding: blood escaping from the vessels does not reach the outside but remains inside the body, collecting in natural cavities ( endocavity hemorrhages ) or in the thickness of the tissues surrounding the lesion ( interstitial hemorrhages ). This category includes both small subcutaneous blood loss of traumatic origin and severe bleeding due to the rupture of blood vessels in the chest, abdomen or skull.
- Externalized internal bleeding: the blood coming out of the vessels reaches the outside through natural orifices (nose, mouth, anus, vagina, ear canal, urethral orifice).
Unlike the external ones, which allow to evaluate the quantity of blood lost and the anatomical component involved, internal hemorrhages are difficult to recognize; for this reason the diagnosis is mainly based on the observation of symptoms due to the state of acute anemia. It is necessary to suspect the presence of an internal hemorrhage every time that penetrating wounds are observed in the skull, in the trunk or in the abdomen; blood or fluids containing blood in the ears or nose; vomiting or cough with blood; hematomas on the chest, abdomen, neck and limbs; blood in the urine or vaginal or rectal hemorrhage; pelvic bone fracture; pallor, sweating, increased heart rate and altered consciousness.
Causes
Based on their cause, they are distinguished in traumatic and spontaneous bleeding.
- Traumatic haemorrhages: due to wounds or bruises involving rupture of deep organs. They can be both internal and external (most frequently external).
- Spontaneous or pathological haemorrhages : they appear apparently without reason or as a result of minor trauma; their appearance is due to a pre-existing pathological condition that weakens or causes a vessel to break (aneurysm, tumors, varicose veins, atherosclerosis, etc.) or due to a bleeding defect (hemophilia). They can be both internal and external (more frequently internal).
Location
Based on location:
bleeding usually takes the name of the organ or anatomical area concerned ( abdominal, gastric, cerebral, cardiac, vaginal haemorrhage etc.); other times they take on particular names ( epistaxis = nosebleed; rectal or proctorrhagia = hemorrhage from the rectum).
What to do - First aid
How to cope with bleeding
In an adult human organism the total amount of circulating blood is equal to about 8% of the body weight, for a total of about 5 - 6 liters. The sudden and rapid reduction in blood volume is responsible for the characteristic signs of hemorrhage.
If the blood loss is substantial, hypovolemic or hemorrhagic shock occurs; this condition, which can arise already due to losses of 3/4 of a liter and become lethal due to bleeding of 1.5 - 2 liters, is characterized by tachycardia (ie an increase in heart rate) or bradycardia (when the situation is very compromised); it is also accompanied by pallor, sweating, hypothermia, hypotension, rapid and frequent breathing, thirst, dyspnea and syncope. If the patient is not immediately helped, the pressure is further lowered, the skin becomes bluish (cyanosis) and death occurs.
Waiting for the emergency services it is therefore essential to put into practice the first aid rules, which will differ according to the type and extent of the bleeding.
In case of external bleeding
Free the damaged part from the clothes; with a sterile gauze or a clean tissue compress the bleeding point upstream (ie in an area chosen along the path of the artery between the heart and the wound) if it is an arterial vessel, downstream (ie after the lesion towards the bodily extremities) if it is a venous hemorrhage.
When the blood loss is abundant it is necessary to wrap the wound with a certain pressure (greater in the presence of arterial hemorrhage, less when it is of venous origin); the tourniquets will be applied only 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, lift it higher than the body. If the bleeding is venous and the wound compression is impossible due to the presence of foreign bodies (such as glass or wood splinters), this simple trick reduces bleeding in an important way.
If the bleeding affects the head, the patient should be kept in a relaxed position.
Once applied, avoid removing the compression bandage, even if it is made with blood, in the following two hours (in order to allow the natural closure of the vessels and to prevent the loss of the pressure exerted by the bandage to facilitate the leakage of blood from the lesion) .
Direct compression and uplift of the limb are contraindicated in case of suspected fracture or dislocation, in the 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 such situations it is possible to attempt remote compression on the points where the main artery carrying blood in the injured district runs on the surface and directly above a bone (site where the arterial pulse is perceived). 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 the previous methods have not stopped the bleeding, in amputations, in trauma from prolonged crushing of the limbs (over 7-8 hours) and in maxi-emergencies. Made of soft, broad 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 too long, it can cause irreparable damage to the nervous and vascular structures. For the same reason it is necessary to note the time of application and make a sign (an L) on the patient's forehead in order to signal its presence even when it is covered during transport to the hospital. Venous hemorrhages, even if of considerable magnitude, never justify the use of the tourniquet.
Beware of the signs of collapse that often take over in case of major bleeding (pallor, dizziness, cold sweating). In this case the subject should be placed in an anti-shock position (supine, with the head down and the 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; immediately alert the medical aid and do not give anything by mouth. In the presence of otorrhagia resulting in head injury (blood loss 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 bleeding. Analogous speech in case of epistaxis consequent to head trauma. If instead the hemorrhage of the blood vessels present in the nasal cavities does not follow a head injury, place the victim in a sitting position with the head slightly bent forward, unfasten the clothes around the neck and compress the bleeding nostril with a finger for a few minutes; useful, if possible, cooling with ice or cold water at the root of the nose; it is also important, to stop bleeding, to avoid blowing or rubbing the nose.
