• Definition
    • Bleeding is the loss of blood. Bleeding may be:

      • Inside the body (internally) 
      • Outside the body (externally)

      Bleeding may occur:

      • Inside the body when blood leaks from blood vessels or organs
      • Outside the body when blood flows through a natural opening (such as the vagina, mouth, or rectum)
      • Outside the body when blood moves through a break in the skin
  • Alternative Names
    • Blood loss; Open injury bleeding

  • Considerations
    • Get emergency medical help for severe bleeding. This is very important if you think there is internal bleeding. Internal bleeding can very quickly become life threatening. Immediate medical care is needed.

      Serious injuries may cause heavy bleeding. Sometimes, relatively minor injuries can bleed a lot. An example is a scalp wound.

      You may bleed a lot if you take blood-thinning medication or have a bleeding disorder such as hemophilia. Bleeding in such people requires immediate medical attention.

      The most important step for external bleeding is to apply direct pressure. This will stop most external bleeding.

      Always wash your hands before (if possible) and after giving first aid to someone who is bleeding. This helps prevent infection.

      Try to use latex gloves when treating someone who is bleeding. Latex gloves should be in every first aid kit. People allergic to latex can use a nonlatex glove. You can catch viral hepatitis if you touch infected blood. HIV can be spread if infected blood gets into an open wound, even a small one.

      Although puncture wounds usually don't bleed very much, they carry a high risk of infection. Seek medical care to prevent tetanus or other infection.

      Abdominal and chest wounds can be very serious because of the possibility of severe internal bleeding. They may not look very serious, but can result in shock.

      • Seek immediate medical care for any abdominal or chest wound.
      • If organs are showing through the wound, do not try to push them back into place.
      • Cover the injury with a moistened cloth or bandage.
      • Apply only very gentle pressure to stop the bleeding.

      Blood loss can cause blood to collect under the skin, turning it black and blue (bruised). Apply a cool compress to the area as soon as possible to reduce swelling. Wrap the ice in a towel and place the towel over the injury. Do not place ice directly on the skin.

  • Causes
    • Bleeding can be caused by injuries or may be spontaneous. Spontaneous bleeding is most commonly caused by problems with the joints, or gastrointestinal or urogenital tracts.

  • Symptoms
    • You may have symptoms such as:

      Bleeding can also cause shock, which may include any of the following symptoms:

      Symptoms of internal bleeding may include:

      • Abdominal pain and swelling
      • Chest pain
      • Skin color changes that occur several days after an injury (skin color may be black, blue, purple, yellowish green)

      Blood coming from a natural opening in the body may also be a sign of internal bleeding. These symptoms include:

  • First Aid
    • First aid is appropriate for external bleeding. If bleeding is severe, or if you think there is internal bleeding, or the person is in shock, get emergency help.

      1. Calm and reassure the person. The sight of blood can be very frightening.
      2. If the wound affects just the top layers of skin (superficial), wash it with soap and warm water and pat dry. Bleeding from superficial wounds or scrapes is often described as "oozing," because it is slow.
      3. Lay the person down. This reduces the chances of fainting by increasing blood flow to the brain. When possible, raise up the part of the body that is bleeding.
      4. Remove any loose debris or dirt that you can see from a wound.
      5. Do NOT remove an object such as a knife, stick, or arrow that is stuck in the body. Doing so may cause more damage and bleeding. Place pads and bandages around the object and tape the object in place.
      6. Put pressure directly on an outer wound with a sterile bandage, clean cloth, or even a piece of clothing. If nothing else is available, use your hand. Direct pressure is best for external bleeding, except for an eye injury.
      7. Maintain pressure until the bleeding stops. When it has stopped, tightly wrap the wound dressing with adhesive tape or a piece of clean clothing. Place a cold pack over the dressing. Do not peek to see if the bleeding has stopped.
      8. If bleeding continues and seeps through the material being held on the wound, do not remove it. Simply place another cloth over the first one. Be sure to seek medical attention.
      9. If the bleeding is severe, get medical help and take steps to prevent shock. Keep the injured body part completely still. Lay the person flat, raise the feet about 12 inches (30 centimeters), and cover the person with a coat or blanket. DO NOT move the person if there has been a head, neck, back, or leg injury, as doing so may make the injury worse. Get medical help as soon as possible.
  • Do Not
    • DO NOT apply a tourniquet to control bleeding, except as a last resort. Doing so may cause more harm than good. A tourniquet should be used only in a life-threatening situation and should be applied by an experienced person

      If continuous pressure has not stopped the bleeding and bleeding is extremely severe, a tourniquet may be used until medical help arrives or bleeding is controllable.

      • The tourniquet should be applied to the limb between the bleeding site and the heart and tightened so bleeding can be controlled by applying direct pressure over the wound.
      • To make a tourniquet, use bandages 2 to 4 inches (5 to 10 centimeters) wide and wrap them around the limb several times. Tie a half or square knot, leaving loose ends long enough to tie another knot. A stick or a stiff rod should be placed between the two knots. Twist the stick until the bandage is tight enough to stop the bleeding and then secure it in place.
      • Check the tourniquet every 10 to 15 minutes. If the bleeding becomes controllable, (manageable by applying direct pressure), release the tourniquet.

      DO NOT peek at a wound to see if the bleeding is stopping. The less a wound is disturbed, the more likely it is that you will be able to control the bleeding.

      DO NOT probe a wound or pull out any embedded object from a wound. This will usually cause more bleeding and harm.

      DO NOT remove a dressing if it becomes soaked with blood. Instead, add a new one on top.

      DO NOT try to clean a large wound. This can cause heavier bleeding.

      DO NOT try to clean a wound after you get the bleeding under control. Get medical help.

  • When to Contact a Medical Professional
    • Seek medical help if:

      • Bleeding can't be controlled, it required the use of a tourniquet, or it was caused by a serious injury
      • The wound might need stitches
      • Gravel or dirt can't be removed easily with gentle cleaning
      • You think there may be internal bleeding or shock
      • Signs of infection develop, including increased pain, redness, swelling, yellow or brown fluid, swollen lymph nodes, fever, or red streaks spreading from the site toward the heart
      • The injury was due to an animal or human bite
      • The patient has not had a tetanus shot in the last 5 to 10 years
  • Prevention
    • Use good judgment and keep knives and sharp objects away from small children.

      Stay up-to-date on vaccinations, especially immunization for tetanus.

  • References
    • Blackwell T. Emergency medical services: overview and ground transport. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 190.

      Cornwell EE. Initial approach to trauma. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004:chap 251.

      Lammers RL. Principles of wound management. In: Roberts JR, Hedges JR, eds. Roberts: Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia, PA: Elsevier Saunders; 2009:chap 39. 

      Simon BC, Hern HG. Wound management principles. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 59.