Definition and Types of Hemorrhage
Hemorrhage refers to the leakage of blood from the vessels. Depending on the affected component, we can speak of arterial, venous, mixed and capillary haemorrhage.
- Arterial haemorrhage: the bright red blood comes out in the form of a more or less intense jet 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 be up to a few meters.
- Venous haemorrhage: blood, dark red in color, continuously leaks from the edges of the wound, like water from an overflowing glass; the edges and surrounding skin appear stained with blood.
- Mixed haemorrhage: the lesion affects both venous and arterial vessels; the blood comes out without jets but in quantity and with greater rapidity than the venous hemorrhages.
- Capillary haemorrhage: the blood, of bright red color, comes out with a slow but continuous flow.
Internal and External Hemorrhages
Based on their location, hemorrhages are divided into external, internal and externalized internal.
- External haemorrhages: the blood comes out of the body as a result of a trauma that has damaged the skin and underlying structures.
- Internal bleeding: the blood leaking from the vessels does not reach the outside but remains inside the body, collecting in natural cavities (intracavitary haemorrhages) or in the thickness of the tissues surrounding the lesion (interstitial bleeding). This category includes both small subcutaneous blood losses of traumatic origin and severe haemorrhages due to the 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 the external ones, which allow to evaluate the quantity of lost blood 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 internal bleeding whenever penetrating wounds are observed in the skull, trunk or abdomen; blood or liquids containing blood in the ears or nose; vomiting or coughing with 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 impaired consciousness.
Causes
Based on their cause, they are divided into traumatic and spontaneous hemorrhages.
- 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 for no reason or as a result of 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 bleeding defect (haemophilia). They can be both internal and external (most frequently internal).
Location
By location:
hemorrhages usually take the name of the organ or anatomical area involved (abdominal, gastric, cerebral, cardiac, vaginal haemorrhage etc.); at other times they take on particular names (epistaxis = nosebleed; rectorrhagia or proctorrhagia = haemorrhage from the rectum).
What to do - First aid
How to cope with a "bleeding
In an adult human organism the total quantity of circulating blood is equal to about 8% of the body weight, for a total of about 5 - 6 liters. The abrupt and rapid reduction of the blood volume is responsible for the characteristic signs of haemorrhage.
If the blood loss is consistent, hypovolemic or hemorrhagic shock occurs; this condition, which can already arise from losses of 3/4 of a liter and become lethal due to haemorrhages of 1.5 - 2 liters, is characterized by tachycardia (i.e. 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, dyspnoea and syncope. If the patient is not immediately rescued, the pressure undergoes a further lowering, 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 according to the type and extent of the bleeding.
In case of external bleeding
Free the injured party from clothing; with a sterile gauze or clean tissue compress the bleeding point upstream (i.e. in a chosen area along the path of the artery between the heart and the wound) if it is an arterial vessel, downstream (i.e. after the injury towards the body extremities) if it is a "venous hemorrhage.
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 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 hemorrhage is venous and the compression of the wound is prevented by the presence of foreign bodies (such as glass or wood splinters), this simple measure allows to significantly reduce the bleeding.
If the bleeding affects the head, the patient should be kept in a lying position.
Once applied, avoid removing the compressive bandage, even if it is soaked with blood, in the following two hours (in order to allow the natural closure of the vessels and avoid that the loss of pressure exerted by the bandage facilitates the escape of blood from the lesion) .
Direct compression and limb lifting 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 these from causing further damage to adjacent structures). 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 over a bone (site where the arterial pulse is felt). In this way the artery is squeezed against the underlying hard formations and 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. Of soft and broadband material (5- 7 cm), the tourniquet should be placed 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 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 bleeding, even if of considerable entity, does not never justify the use of the tourniquet.
Beware of the signs of collapse that often occur in case of major bleeding (pallor, dizziness, cold sweat). In this case the subject must be placed in an antishock 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; call for medical assistance immediately and do not give anything by mouth. In the presence of otorrhagia resulting from head trauma (bleeding 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. on the other hand, the haemorrhage of the blood vessels present in the nasal cavities does not follow a head trauma it is necessary to put the victim in a sitting position with the head slightly bent forward, undo the clothes around the neck and compress the bleeding nostril with a finger for a few minutes; if possible, cooling with ice or cold water at the root of the nose is useful; it is also important, once the bleeding has stopped, to avoid blowing or rubbing the nose.
