HEMORRHAGE: UNDERSTANDING HEMORRHAGE

A bleeding patient

HEMORRHAGE: UNDERSTANDING HEMORRHAGE: Hemorrhage is the medical term for the escape of blood from blood vessels, and it can occur both internally, hidden from view, or externally, where it’s visible to the naked eye. This critical medical condition can have various causes, including direct injuries to blood vessel walls, diseases affecting blood vessels, and blood disorders like hemophilia. Understanding the dangers of hemorrhage, its classifications, signs, and treatment options is crucial for everyone, especially first aiders, as hemorrhage can quickly become a life-threatening situation.

Causes of Hemorrhage

Hemorrhage can be triggered by different factors:

1. Direct Injury: Trauma, wounds, or surgical procedures can damage blood vessels, causing them to bleed.

2. Disease: Infections or malignancies, such as cancer, can weaken blood vessel walls, making them prone to bleeding.

3. Blood Disorders: Conditions like hemophilia can lead to prolonged bleeding due to the lack of essential clotting factors.

Dangers of Hemorrhage

The dangers of hemorrhage are clear:

– Rapid Fatality: Hemorrhage can result in death within minutes if not addressed promptly.

– First Aid Priority: First aiders must be prepared to manage hemorrhage as it’s one of the most critical conditions they may encounter.

– Critical State: Even slow and continuous bleeding over an extended period can lead to a critical condition.

Classifications of Hemorrhage

Hemorrhage can be classified based on different criteria:

1. By Situation

    a) External Hemorrhage: This involves blood escaping from blood vessels and being visible on the body’s surface.

    b) Internal or Concealed Hemorrhage: Blood escapes into body cavities, organs, or tissues, often hidden from view. Examples include bruises or hematomas. In some cases, such as gastrointestinal bleeding or bleeding in the respiratory tract, the blood may eventually become visible when the patient vomits or coughs it up.

2. By Source

   – Arterial Bleeding: Blood from arteries is bright red due to its oxygen content. It spurts from the wound with each heartbeat, under high pressure.

   – Venous Bleeding: Venous blood is dark red because it contains less oxygen but more carbon dioxide. It flows steadily, usually with less pressure, from the part of the wound farthest from the heart. A definite bleeding point is often visible.

   – Capillary Bleeding: This occurs after minor cuts, scratches, or minor wounds. Blood oozes slowly from the wound with little force, and the blood color is typically ordinary red.

3. By Time of Occurrence (Duration)

   a) Primary Hemorrhage: Immediate bleeding at the time of injury, operation, or due to vascular disease.

   b) Reactionary Hemorrhage: Occurs 24 hours after an injury or operation due to the body’s reaction.

   c) Secondary Hemorrhage: A serious complication with bleeding recurring after the first 24 hours, often from the seventh to tenth day following injury, and usually associated with infection. Microorganisms can destroy blood clots that act as seals and damage newly formed tissues involved in natural repair.

Signs and Symptoms of Hemorrhage

Recognizing the signs and symptoms of hemorrhage is crucial for timely intervention:

1. Skin Changes: The skin becomes pale and cold to the touch as superficial blood vessels constrict.

2. Sweating: The skin may be covered in sweat as the body diverts blood to vital organs.

3. Subnormal Body Temperature: Constricted superficial blood vessels can lead to a lowered body temperature.

4. Rapid and Weak Pulse: The heart beats rapidly and weakly as it compensates for blood loss. In severe cases, the pulse may become faint.

5. Lowered Blood Pressure: Blood pressure drops due to reduced blood volume.

6. Respiratory Changes: The patient may experience rapid, shallow breathing and a sense of “air hunger” due to reduced oxygen capacity in the blood.

7. Anxiety and Restlessness: If conscious, the patient may feel anxious, afraid, and restless.

8. Thirst: Patients often complain of thirst due to fluid loss. However, they should not be given fluids orally.

9. Dehydration: If fluid loss is not replaced, dehydration can occur.

10. Extreme Restlessness: In cases of continued bleeding, the patient may become extremely restless.

11. Neurological Symptoms: Insufficient blood supply to the brain can result in blurred vision, dizziness, ringing in the ears, dilated pupils, confusion, unconsciousness, and, in severe cases, coma and death.

Treatment of Hemorrhage

Proper treatment is essential for managing hemorrhage:

1. Direct Pressure: Apply direct pressure to the wound using your thumb, fingers, or a pad and bandage.

2. Pressure Around the Wound: Use simple pads or ring pads to apply pressure around the wound.

3. Pressure on the Heart Side: In cases of severe bleeding, consider pressure points or tourniquets as a last resort, but use them with caution.

First Aid Treatment for Hemorrhage

First aid principles for hemorrhage management include:

1. Arrest the Hemorrhage: The primary goal is to stop the bleeding.

2. Treat for Shock: Assist the patient in maintaining normal blood flow to vital organs and tissues.

3. Seek Medical Help: Arrange for the patient to receive professional medical care as soon as possible.

Special Hemorrhages

1. Epistaxis (Nosebleed): Management includes keeping the patient calm, seated with the head tilted forward, and avoiding blowing the nose.

2. Bleeding from a Tooth Socket: After tooth extraction, ice, gauze or cotton wool, and firm tooth clenching can help control bleeding.

3. Haemoptysis (Coughing Up Blood): Patients should sit up or be propped up, avoid swallowing, and suck on ice to control bleeding.

4. Haematemesis (Vomiting Blood): Keep the patient lying down, remove tight clothing, and provide ice to suck on while arranging immediate medical care.

5. Melaena (Black, Tarry Stools): Keep the patient at rest, save specimens of stools and blood for inspection, and seek medical help.

6. Haematuria (Blood in Urine): Reassure the patient, keep them at rest, save urine samples, and arrange for medical aid.

7. Uterine Bleeding: Place the patient in bed with raised feet, apply a pad to the vulva, and seek medical attention.

8. Bleeding from a Varicose Vein: Keep the patient lying down with the elevated limb and apply direct pressure to the wound, removing constricting clothing and preventing shock.

Understanding hemorrhage and knowing how to respond can save lives in critical situations. Whether you’re a trained medical professional or a concerned bystander, being prepared to address hemorrhage can make a significant difference in a person’s chances of survival. Always remember to seek professional medical assistance when dealing with hemorrhage to ensure the best possible outcome for the patient.