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нська oʻzbekcha ўзбекча tiếng việt 中文 edit links article talk english read edit view history tools tools move to sidebar hide actions read edit view history general what links here related changes upload file permanent link page information cite this page get shortened url switch to legacy parser print export download as pdf printable version in other projects wikimedia commons wikidata item appearance move to sidebar hide from wikipedia the free encyclopedia leakage of blood within the body this article is about the medical condition for the death metal band see internal bleeding medical condition internal bleeding other names internal hemorrhage internal bleeding in the brain specialty vascular surgery hematology emergency medicine complications hemorrhagic shock exsanguination internal bleeding also called internal haemorrhage is a loss of blood from a blood vessel that collects inside the body and is not usually visible from the outside 1 it can be a serious medical emergency but the extent of severity depends on bleeding rate and location of the bleeding e g head torso extremities severe internal bleeding into the chest abdomen pelvis or thighs can cause hemorrhagic shock or death if proper medical treatment is not received quickly 2 internal bleeding is a medical emergency and should be treated immediately by medical professionals 2 signs and symptoms edit signs and symptoms of internal bleeding may vary based on location presence of injury or trauma and severity of bleeding common symptoms of blood loss may include lightheadedness fatigue urinating less than usual confusion fast heart rate pale and or cold skin thirst generalized weakness visible signs of internal bleeding include blood in the urine dark black stools bright red stools bloody noses bruising throwing up blood of note it is possible to have internal bleeding without any of the above symptoms and pain may or may not be present 3 a patient may lose more than 30 of their blood volume before there are changes in their vital signs or level of consciousness 4 this is called hemorrhagic or hypovolemic shock which is a type of shock that occurs when there is not enough blood to reach organs in the body 5 causes edit internal bleeding can be caused by a broad number of things and can be broken up into three large categories trauma or direct injury to blood vessels within the body cavity genetic and acquired conditions along with various medications that result in an increased bleeding risk other traumatic edit the most common cause of death in trauma is bleeding 6 death from trauma accounts for 1 5 million of the 1 9 million deaths per year due to bleeding 4 there are two types of trauma penetrating trauma and blunt trauma 2 penetrating trauma is the most common cause of vascular injury and can result in internal bleeding it can occur after a ballistic injury or stab wound if penetrating trauma occurs in blood vessels close to the heart it can quickly lead to hemorrhagic or hypovolemic shock exsanguination and death 2 blunt trauma is another cause of vascular injury that can result in internal bleeding it can occur after a high speed deceleration in an automobile accident 2 7 non traumatic edit a number of pathological conditions and diseases can lead to internal bleeding these include blood vessel rupture as a result of high blood pressure aneurysms peptic ulcers or ectopic pregnancy 8 other diseases linked to internal bleeding include cancer hematologic disease vitamin k deficiency and rare viral hemorrhagic fevers such as the ebola dengue or marburg viruses 9 other edit this stomach with linitis plastica brinton s disease can cause internal bleeding internal bleeding could be a result of complications following surgery or other medical procedures some medications may also increase a person s risk for bleeding such as anticoagulant drugs or antiplatelet drugs in the treatment of coronary artery disease 10 diagnosis edit vital signs edit blood loss can be estimated based on heart rate blood pressure respiratory rate and mental status 11 blood is circulated throughout the body and all major organ systems through a closed loop system when there is damage to the blood vessel or the blood is thinner than the physiologic consistency blood can exit the vessel which disrupts this close looped system the autonomic nervous system ans responds in two large ways as an attempt to compensate for the opening in the system these two actions are easily monitored by checking the heart rate and blood pressure blood pressure will initially decrease due to the loss of blood this is where the ans comes in and attempts to compensate by contracting the muscles that surround these vessels as a result a person who is bleeding internally may initially have a normal blood pressure when the blood pressure falls below the normal range this is called hypotension the heart will start to pump faster causing the heart rate to increase as an attempt to get blood delivered to vital organ systems faster when the heart beats faster than the healthy and normal range this is called tachycardia if the bleeding is not controlled or stopped a patient will experience tachycardia and hypotension which altogether is a state of shock called hemorrhagic shock advanced trauma life support atls by the american college of surgeons separates hemorrhagic shock into four categories 12 4 13 classification of hemorrhagic shock 12 4 13 estimated blood loss heart rate per minute blood pressure pulse pressure mmhg respiratory rate per minute other class i hemorrhage 15 normal or minimally elevated normal normal normal slightly anxious class ii hemorrhage 15 30 100 120 normal or minimally decreased systolic blood pressure narrowed 20 30 mildly anxious cool clammy skin with delayed capillary refill class iii hemorrhage 30 40 120 140 systolic blood pressure 90 mmhg or change in blood pressure 20 30 from presentation narrowed 30 40 altered mental status anxious confused decreased urine output class iv hemorrhage 40 140 systolic blood pressure 90 mmhg narrowed 25 mmhg 35 significantly altered mental status confused lethargic cool clammy skin with delayed capillary refill significantly decreased or absent urine output assessing circulation occurs after assessing the patient s airway and breathing abc medicine 5 if internal bleeding is suspected a patient s circulatory system is assessed through palpation of pulses and doppler ultrasonography 2 physical examination edit it is important to examine the person for visible signs that may suggest the presence of internal bleeding and or the source of the bleed 2 some of these signs may include a wound bruising ecchymosis blood collection hematoma abnormal skin sensation paresthesia signs of compartment syndrome imaging edit if internal bleeding is suspected a fast exam may be performed to look for bleeding in the abdomen 2 12 if the patient has stable vital signs they may undergo diagnostic imaging such as a ct scan 4 if the patient has unstable vital signs they may not undergo diagnostic imaging and instead may receive immediate medical or surgical treatment 4 treatment edit management of internal bleeding depends on the cause and severity of the bleed internal bleeding is a medical emergency and should be treated immediately by medical professionals 2 fluid replacement edit if a patient has low blood pressure hypotension intravenous fluids can be used until they can receive a blood transfusion in order to replace blood loss quickly and with large amounts of iv fluids or blood patients may need a central venous catheter 12 patients with severe bleeding need to receive large quantities of replacement blood via a blood transfusion as soon as the clinician recognizes that the patient may have a severe continuing hemorrhage requiring more than 4 units in 1 hour or 10 units in 6 hours they should initiate a massive transfusion protocol 12 the massive transfusion protocol replaces red blood cells plasma and platelets in varying ratios based on the cause of the bleeding traumatic vs non traumatic 4 stopping the bleeding edit it is crucial to stop the internal bleeding immediately achieve hemostasis after identifying its cause 4 the longer it takes to achieve hemostasis in people with traumatic causes e g pelvic fracture and non traumatic causes e g gastrointestinal bleeding ruptured abdominal aortic aneurysm the higher the death rate is 4 unlike with external bleeding most internal bleeding cannot be controlled by applying pressure to the site of injury 12 internal bleeding in the thorax and abdominal cavity including both the intraperitoneal and retroperitoneal space cannot be controlled with direct pressure compression a patient with acute internal bleeding in the thorax after trauma should be diagnosed resuscitated and stabilized in the emergency department in less than 10 minutes before undergoing surgery to reduce the risk of death from internal bleeding 4 a patient with acute internal bleeding in the abdomen or pelvis after trauma may require use of a reboa device to slow the bleeding 4 the reboa has also been used for non traumatic causes of internal bleeding including bleeding during childbirth and gastrointestinal bleeding 4 internal bleeding from a bone fracture in the arms or legs may be partially controlled with direct pressure using a tourniquet 12 after tourniquet placement the patient may need immediate surgery to find the bleeding blood vessel 4 internal bleeding where the torso meets the extremities junctional sites such as the axilla or groin cannot be controlled with a tourniquet however there is an fda approved device known as an abdominal aortic and junctional tourniquet aajt designed for proximal aortic control although very few studies examining its use have been published 14 15 16 17 18 19 for bleeding at junctional sites a dressing with a blood clotting agent hemostatic dressing should be applied 4 a campaign to improve the care of bleeding known as the stop the bleed campaign is also taking place 20 references edit auerback paul field guide to wilderness medicine pdf 12 ed pp 129 131 retrieved 13 march 2019 1 2 3 4 5 6 7 8 9 fritz davis 2011 vascular emergencies current diagnosis treatment emergency medicine 7e ed new york mcgraw hill isbn 978 0071701075 dynamed www dynamed com retrieved 2023 10 08 1 2 3 4 5 6 7 8 9 10 11 12 13 14 cannon jeremy january 25 2018 hemorrhagic shock the new england journal of medicine 378 4 370 379 doi 10 1056 nejmra1705649 pmid 29365303 s2cid 205117992 1 2 international trauma life support for emergency care providers pearson education limited 2018 pp 172 173 isbn 978 1292 17084 8 teixeira pedro g r inaba kenji hadjizacharia pantelis brown carlos salim ali rhee peter browder timothy noguchi thomas t demetriades demetrios december 2007 preventable or potentially preventable mortality at a mature trauma center the journal of trauma injury infection and critical care 63 6 1338 46 discussion 1346 7 doi 10 1097 ta 0b013e31815078ae pmid 18212658 duncan nicholas s moran chris 2010 i initial resuscitation of the trauma victim orthopaedics and trauma 24 1 8 doi 10 1016 j mporth 2009 12 003 lee edward w laberge jeanne m 2004 differential diagnosis of gastrointestinal bleeding techniques in vascular and interventional radiology 7 3 112 122 doi 10 1053 j tvir 2004 12 001 pmid 16015555 bray m 2009 hemorrhagic fever viruses encyclopedia of microbiology pp 339 353 doi 10 1016 b978 012373944 5 00303 5 isbn 9780123739445 pospíšil jan hromádka milan bernat ivo rokyta richard 2013 stemi the importance of balance between antithrombotic treatment and bleeding risk cor et vasa 55 2 e135 e146 doi 10 1016 j crvasa 2013 02 004 current diagnosis treatment emergency medicine mcgraw hill 2011 05 23 isbn 978 0071701075 1 2 3 4 5 6 7 colwell christopher initial management of moderate to severe hemorrhage in the adult trauma patient uptodate retrieved 5 march 2019 1 2 atls advanced trauma life support student course manual 10th ed american college of surgeons 2018 pp 43 52 isbn 978 78 0 9968267 croushorn j abdominal aortic and junctional tourniquet controls hemorrhage from a gunshot wound of the left groin jspecopermed 2014 14 2 6 8 croushorn j thomas g mccord sr abdominal aortic tourniquet controlsjunctional hemorrhage from a gunshot wound of the axilla j spec oper med 2013 13 3 1 4 rall jm ross jd clemens ms cox jm buckley ta morrison jj hemo dynamic effects of the abdominal aortic and junctional tourniquet in ahemorrhagic swine model jsurgres 2017 212 159 166 kheirabadi bs terrazas ib miranda n voelker an grimm r kragh jf jr dubick ma physiological consequences of abdominal aortic and junc tional tourniquet aajt application to control hemorrhage in a swinemodel shock augusta ga 2016 46 3 suppl 1 160 166 taylor dm coleman m parker pj the evaluation of an abdominal aortictourniquet for the control of pelvic and lower limb hemorrhage mil med 2013 178 11 1196 1201 brannstrom a rocksen d hartman j et al abdominal aortic and junctional tourniquet release after 240 minutes is survivable and associated with small intestine and liver ischemia after porcine class ii hemorrhage j trauma acute care surg 2018 85 4 717 724 doi 10 1097 ta 0000000000002013 pons md peter stop the bleed save a life what everyone should know to stop bleeding after an injury archived from the original on september 28 2016 external links edit the wikibook first aid has a page on the topic of internal bleeding v t e trauma principles polytrauma major trauma traumatology triage resuscitation trauma triad of death assessment clinical prediction rules abbreviated injury scale injury severity score naca score revised trauma score investigations diagnostic peritoneal lavage focused assessment with sonography for trauma management principles advanced trauma life support damage control surgery early appropriate care trauma center trauma surgery trauma team procedures resuscitative thoracotomy pathophysiology injury msk bone fracture degloving joint dislocation soft tissue injury respiratory diaphragmatic rupture flail chest hemothorax pneumothorax pulmonary contusion cardio cardiac tamponade internal bleeding thoracic aorta injury gi blunt kidney trauma splenic injury neuro intracranial hemorrhage penetrating head injury traumatic brain injury mechanism blast injury blunt trauma burn crush injury electrocution gunshot wound penetrating trauma stab wound region abdominal trauma chest injury facial trauma head injury spinal cord injury demographic geriatric trauma pediatric trauma complications acute respiratory distress syndrome chronic traumatic encephalopathy compartment syndrome contracture volkmann s contracture crush syndrome rhabdomyolysis embolism air fat post traumatic stress disorder subcutaneous emphysema wound healing retrieved from https en wikipedia org w index php title internal_bleeding oldid 1372809533 categories bleeding injuries medical 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