Major Wound Care

Severe Internal Bleeding

Severe internal bleeding (also referred to as internal hemorrhages). The simplest and most common form of internal bleeding will result in a bruise (such as from bumping into a table). A more serious case of internal bleeding requires immediate medical attention, since the bleeding cannot be easily controlled. These injuries usually require surgery.

Severe internal bleeding should be suspected when:

  • The casualty receives a severe blow or penetrating injury to the chest, neck, abdomen, or groin.
  • There are major limb fractures, such as an upper leg or pelvis injury.
  • There was an impact or a fall that is also a concern for a head and spinal injury.

Signs and Symptoms of Severe Internal Bleeding

The following are the signs and symptoms of severe internal bleeding:

  • Bleeding from the ear canal or the nose
  • Bloodshot or black eye (bleeding inside the head)
  • Large area of bruising and swelling
  • Coughing up blood that is bright red and frothy (bleeding into the lungs)
  • Vomiting bright red blood, or brown blood that looks like coffee grounds
  • Blood in the stool that looks either red or black and tarry
  • Red or smoky brown blood in the urine
  • Signs of shock with no signs of external injury

First Aid for Severe Internal Bleeding

To give first aid for severe internal bleeding, perform the following steps:

  1. Perform a scene survey.
  2. Send or go for medical help.
  3. Perform a primary survey.
  4. Position the casualty appropriately – on their back if responsive, in recovery position if unresponsive, or in the position found if head and spinal injuries are suspected.
  5. Give ongoing casualty care and give first aid for shock.

You can do very little to control internal bleeding. Give first aid to minimize shock and get medical help as quickly as you can.

Contusions

Contusions (the medical term for bruises) are caused when small blood vessels are torn and the blood leaks and then collects in a localized area. As there is no external bleeding to control, first aiders are unable to “manage” an internal bleed, but should note it as a sign of a potentially severe internal injury.

Contusions could be anything from a minor soft tissue injury such as sprains or strains (ligament damage) with associated swelling, etc., to something much more dangerous, such as bruising around the eyes or behind the ears (skull fracture).

Treatment for a major contusion will usually require medical referral and possibly treatment in an emergency room setting, so recognition is the most essential treatment for this type of injury.

It is important for the first aider to consider the possibility of contusions during their follow-up care. For example, a worker slips and falls, but denies any injuries. They return to work, but return to the first aid later experiencing other symptoms of concussion, such as headache, nausea, and difficulty recalling information. The first aider may see bruising around the casualty’s eyes or bruising behind the ears, indicating a severe head and neck injury, and should immediately call 9-1-1.