Bleeding Emergencies (Hemorrhaging)

A bleeding emergency, or hemorrhage, is a crisis in which steps must be taken promptly to stop loss of blood before it becomes life threatening. On average, an adult has about 10.5 pints of blood; the loss of even two pints can be fatal.

After a serious accident, injury, or rupture of a major artery, a bleeding emergency may come on rapidly. It develops more slowly when blood loss is associated with an ulcer or other chronic condition, but diagnosis and treatment are still mandatory. For example, many disorders involving internal organs, especially the kidneys, stomach, colon, uterus, and lungs, may lead to a bleeding emergency. Manifestations range from bleeding in an eye or ear, to vomiting or coughing up large amounts of blood, to severe bleeding from the vagina or rectum.

Excessive blood loss is also one of the risks of major surgery. In anticipation of this possibility, a patient might consider providing a quantity of his own blood beforehand so that it will be available if needed. If this is not feasible, the lost blood can be replaced with donor transfusions.

Any unexpected bleeding, even though not severe enough to be considered an emergency, also warrants prompt diagnosis. Examples include profuse rectal bleeding; vaginal bleeding not associated with menstruation; blood in the urine; or unexplained bruises. In such cases, tests are usually needed to detect the underlying cause.

Diagnostic Studies and Procedures

Heavy blood loss from an open wound requires immediate first aid. If you are the only person available to do this at the time of an accident, start first aid right after calling the emergency medical service.

In assessing a bleeding emergency, a doctor tries to determine the source of the bleeding, the volume of blood lost, and whether the patient is in shock. Finding the source of internal bleeding is sometimes difficult; a physician will look for unusual swelling, tenderness, bruises, and bleeding from body openings. Vital signs -- blood pressure, heart and respiration rate, and consciousness -- will also be noted.

Bright red blood spurting from a wound indicates that an artery has been severed; it demands attention before the slower, steady bleeding of an injured vein. Other factors to consider include:

• Bleeding that persists despite all efforts to control it.
• Any deep puncture or laceration.
• Severed or crushed nerve, tendon, bone, or muscle.
• Skin broken by a bite.
• Heavy contamination of a wound by soil or organic matter.
• Foreign object(s) imbedded deep in the tissue.

As soon as a patient has been stabilized, X-rays and other studies may be ordered to find sites of internal bleeding. A CT scan or MRI should be done if there is a possibility of a head injury and bleeding inside the skull.

Medical Treatments

The first priority is to stop the bleeding. If this cannot be accomplished by applying pressure to the related artery, emergency surgery may be performed to repair the damaged blood vessels and close the wound.

Follow-up treatment for a severe open wound depends on its origin. In most cases, antibiotics are given to guard against infection. The wound is cleansed, foreign matter is removed, topical antibacterial salve is applied if needed, and a new dressing is put on.

If the wound is the result of an animal bile, the local health department must be contacted and, if appropriate, rabies immunization carried out. A tetanus shot may also be administered.

Treatment for closed wounds is based on evidence of internal damage as revealed by diagnostic studies. If a significant amount of blood has been lost, transfusions may be necessary. Bleeding associated with anticoagulant drugs such as warfarin (Coumadin) is treated with an injection of vitamin K.

Alternative Therapies

Alternative therapies have a limited role to play in the handling of a bleeding emergency. But both the injured person and the one administering first aid can benefit from a knowledge of deep-breathing exercises to maintain calm. These and other relaxation techniques can also be helpful during recovery from a major hemorrhage or in managing pain during recuperation.

Alternative therapies recommended for less serious bleeding include:

Herbal Medicine. Chinese herbalists advocate agrimony for treating heavy menstrual periods. Indian herbalists prescribe garlic as a remedy for heavy periods. Gel from a freshly cut aloe stem is said to stop bleeding and speed healing of minor cuts.

Nutrition Therapy. Any significant blood loss can lead to iron deficiency anemia. Iron supplements may be prescribed as well as iron-rich food (red meat, liver, egg yolks, and iron-fortified cereal products) to help build new red blood cells. Extra protein is also needed for the repair of tissue, to promote clotting, foods that are rich in vitamin K -- green leafy vegetables, milk, and liver -- are recommended.

Self-Treatment

A knowledge of first aid can make the difference between life and death in any emergency. The American Red Cross offers first aid courses that take just one day, and many community hospitals have similar programs.
A first aid kit should be in the medicine cabinet of every home, the trunk of every car, and the backpack of every hiker. Someone should check it periodically and replenish any supplies as needed.

If a painkiller is needed, do not take aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs, because these medications interfere with the normal clotting of blood. Acetaminophen is a safe alternative.

Other Causes of Bleeding

Abnormal bleeding is a warning sign of many cancers and should never be ignored. Fortunately, most bleeding has easily treated causes. For example, a small amount of blood when brushing the teeth is usually caused by gum disease. Blood in the urine may indicate cystitis or bladder or kidney stones. In athletes, blood in the urine sometimes results from excessive running. Rectal bleeding or blood in the stools usually is due to hemorrhoids, polyps, or inflammation of the colon.