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By: Ikedi Ani-okoye

Internal bleeding

It is vital that the first-aider is able to recognize the signs of internal bleeding and take appropriate action. Internal bleeding can be caused by stabbing or shooting, which also cause external bleeding, or by a fan, a crush injury a punch or kick, a fractured bone or an ulcer, which may not. The signs include cold and clammy, pale skin, weakness, thirst, and blood coming from an orifice. The casualty needs urgent medical assistance, so the most effective action you can take is to call the emergency services.

Unlike external bleeding, internal bleeding is a difficult condition to assess. It may be unclear what is happening until the problem is at a late stage, when the casualty has already bled a great deal and is going into shock. Detecting internal bleeding early on, and getting rapid expert assistance, is by far the most helpful action you can perform under these circumstances.

Causes of internal bleeding

Stabbing and shooting are obvious causes of internal bleeding, and the size of an external wound is often no indicator of the extent of the internal damage. Internal blood vessels and organs can tear and rupture without any obvious external damage.

An injury caused by an object that is not sharp enough to penetrate the skin is called "blunt trauma". This may be due to any number of causes - from a fall, a car accident or crush injury to direct punches or kicks. A warning sign of possible internal damage would be bruising on the skin, especially if it is over the abdomen or chest.

Another common cause of internal bleeding is fractured bones, especially the femur and pelvis, which quickly lead to serious blood loss. Conditions such as duodenal and gastric ulcers may lead to profuse internal bleeding.

People with blood-clotting abnormalities such as haemophidlia, or who are on anti-clotting treatment such as warfarin, may bleed headily after relatively minor injuries. Many diseases affecting the liver may adversely affect the blood's ability to clot, and may also cause varices, which are like internal varicose veins - these can bleed catastrophically.

Signs and symptoms of internal bleeding

~ If someone shows signs of shock. This is indicated by: cold, clammy, pale sKin; loss of consciousness on sitting or standing up; thirst and general weakness; a fast, weak pulse.

~ If the victim coughs up blood or vomits blood or anything that looks like blood (bits of gritty brown vomit that look like coffee grounds are a classic sign of a bleeding duodenal ulcer). If they have passed blood from their rectum (back passage). especially black tar-like stools that smell strongly. This is likely to be due to a bleeding ulcer in the stomach or duodenum.

~ If they have been In an accident where they fell from a height; or stopped suddenly, as in a car accident, or fell off a bicycle on to the handle bars.

~ If there is bleeding from the vagina with no obvious cause.

~ If the casualty has bruising, tenderness and/or swelling, especially if it is over the abdominal area. The kidney, spleen and liver may bleed after an accident.