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
Blood loss; Open injury bleeding
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 don't cause heavy bleeding. Sometimes, relatively minor injuries can bleed a lot. An example is a scalp wound.
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.
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.
- Blood coming from an open wound
- Shock, which may cause any of the following symptoms:
Symptoms of internal bleeding may also include:
- Abdominal pain and swelling
- Chest pain
- External bleeding through a natural opening
- Skin color changes that occur several days after an injury (skin may black, blue, purple, yellowish green)
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.
- 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 hasn't stopped the bleeding and bleeding is extremely severe, a tourniquet may be used until medical help arrives or bleeding is controllable.
- It 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 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'll 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
Call immediately for emergency medical assistance if
Seek medical help if:
- Bleeding can't be controlled, required the use of a tourniquet, or was caused by a serious injury
- The wound might need stitches
- Gravel or dirt cannot 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 5-10 years
Use good judgment and keep knives and sharp objects away from small children.
Stay up-to-date on vaccinations, especially the tetanus immunization.
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. Saunders Elsevier; 2009: chap 39.
Last reviewed 1/1/2013 by Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.
- The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
- A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions.
- Call 911 for all medical emergencies.
- Links to other sites are provided for information only -- they do not constitute endorsements of those other sites.