Internal Bleeding Lukáš Dadák Learning Goals ̶ Student will learn situations when to expect internal bleeding. ̶ Student will learn first aid for bleeding from body orifices. According to the vessel Types of Bleeding manifestation • Internal • External • Traumatic • Non-traumatic • Arterial: BRIGHT RED PULSING blood • Venous: DARK RED blood flows slowly but continuously • Capillary: blood slowly seeps from the wound Internal Bleeding ̶ Body cavities: ̶ chest ̶ abdomen ̶ pelvis ̶ joints ̶ Areas bounded by muscle fascia ̶ Very serious, often life threatening ̶ It is not visible ̶ Outside the hospital, difficult to diagnose! Internal Bleeding Traumatic ̶ (Intracranial injury) ̶ Chest / abdomen / pelvis injuries (large vessels, liver, spleen, kidney) ̶ Fractures of long bones Non-Traumatic ̶ Bleeding from esophageal varices ̶ Bleeding from stomach ulcers ̶ Ectopic pregnancy ̶ Rupture of AAA Symptoms of internal bleeding Symptoms of internal bleeding - Shock - Lost of consciousness - Abdominal pain, tense abdominal muscles, relief position - Extensive bruises - Deformities of the limbs - Bleeding from the oral cavity, rectum or vagina; blood in the urine, blood from the ears - Vomiting or coughing up blood - Black, tarry, smelly stool First Aid ̶ SSSABC ̶ It is necessary to think about internal bleeding especially in injuries, car accidents, pregnant women ̶ Always call EMS! Conscious: ̶ Calm the patient, provide him with a relief position ̶ in case of an abdominal injury, place the patient on his back and support the lower limbs ̶ in case of a chest injury, it is advisable to place the patient in a semi-sitting position ̶ Provide the patient with thermal comfort ̶ Treat other visible injuries Bruise (hematoma) Rupture of a blood vessel, spillage of blood into the subcutaneous tissue FA: Light compression with a cold lining (narrowing of blood vessels, reduction of swelling) https://zdravi.euro.cz/leky/hematon-prkotina-i-zivot-ohrozujici-zalezitost/galerie-106670-8 Special Types of Bleeding ̶ From the nose ̶ From the ear ̶ From the mouth ̶ Injury to mouth, lip, tooth ̶ Hematemesis ̶ Hemoptysis ̶ From the rectum ̶ From the genitals Nosebleed https://www.geelongmedicalgroup.com.au/2018/03/what-to-do-when-your-nose-bleeds https://www.geelongmedicalgroup.com.au/2018/03/what-to-do-when-your-nose-bleeds Nosebleed ̶ Hypertensive patients, patients with impaired coagulation (blood clotting), ̶ Young children: there is a risk of inhaling blood. FA: ̶ SSSABC ̶ Sitting in a forward bend, mouth breathing ̶ Squeezing the nasal wings for 5-10 minutes ̶ Cold gauze on the back of the head and/or on the forehead EMS: impaired consciousness, heavy constant bleeding, children at risk of aspiration Bleeding from the ear ̶ Head or eardrum injury ̶ Cerebrospinal fluid may leak FA: ̶ SSSABC ̶ Attach a sterile cover to the outer ear ̶ Conscious patient in a semi-sitting position with his head tilted to the affected side ̶ ENT examination ̶ Do not tampon the ear canal !!! Luxated tooth FA: ̶ Bite tampon = pressure tamponade ̶ Compression must take longer than 20 minutes ̶ Dental treatment ̶ Luxated tooth for replantation: ̶ in a sterile normal saline ̶ in milk ̶ in the oral cavity in saliva if there is certainty of ingestion Hematemesis ̶ It is a bleeding from the digestive tract - vomiting blood ̶ ATTENTION: there is a risk of blood aspiration !!! FA: ̶ Patient in a semi-sitting position - prevention of aspiration ̶ Bent lower limbs - relief position ̶ Call EMS !!! ̶ In case of impaired consciousness, we place the patient in the recovery position (blood can flow out of the mouth) and closely monitor the ABC - in case of respiratory and circulatory arrest we start CPR (we do not take breaths from mouth to mouth) Hemoptysis ̶ Bleeding from the lungs ̶ Typically, coughing up bright red and frothy blood ̶ Many causes, insignificant in first aid FA: ̶ SSSABC ̶ Calm the patient ̶ Half-seat ̶ Call EMS Vaginal Bleeding In pregnancy ̶ Abortion ̶ Placental disorders ̶ Childbirth No connection with pregnancy ̶ Blood clotting disorders ̶ Tumors of the uterus ̶ Injuries of genitals https://www.1mg.com/articles/vaginal-bleeding-what-is-normal/ Acute situation ̶ Abortion - bleeding ̶ EUG - abdominal pain, shock Common symptoms: ̶ atypical course of menstruation ̶ amenorrhea 6 - 8 weeks ̶ positive pregnancy test FA: SSSABC …. hospitalization, gynecological examination Bleeding from the rectum ̶ Bright red blood ̶ External hemorrhoids ̶ Anus crack ̶ Dark blood ̶ Internal hemorrhoids ̶ Diverticulitis, colitis, colon tumor ̶ Digested blood = melena (greasy, tarry) ̶ Bleeding from the upper part of the digestive tract ̶ FA: SSSABC … seek medical aid https://emedicine.medscape.com/article/81039-overview Learning outcomes ̶ Student knows the manifestations of internal bleeding. ̶ Student knows the basic causes of bleeding from body orifices. ̶ Student is able to describe first aid for nosebleeds. Literature ̶ AUSTIN, Margaret, Rudy CRAWFORD and Barry KLAASSEN. First aid manual: the Authorised Manual of St John Ambulance, St Andrew's First Aid and the British Red Cross. Revised 10th edition. London: DK, 2016. 288 pp. ISBN 9780241241233. Simulation Centre, Faculty of Medicine, Masaryk University 2020