SEVERE BLEEDING

Bleeding, technically known as hemorrhaging is the loss of blood or blood escape from the circulatory system. Bleeding can occur internally, where blood leaks from blood vessels inside the body, or externally, either through a natural opening such as the vagina, mouth, nose, ear or anus, or through a break in the skin. Desanguination is a massive blood loss, and the complete loss of blood is referred to as exsanguination. Typically, a healthy person can endure a loss of 10–15% of the total blood volume without serious medical difficulties, and blood donation typically takes 8–10% of the donor's blood volume.

1. Class I Hemorrhage involves up to 15% of blood volume. There is typically no change in vital signs and fluid resuscitation is not usually necessary.

2. Class II Hemorrhage involves 15-30% of total blood volume. A patient is often tachycardic (rapid heart beat) with a narrowing of the difference between the systolic and diastolic blood pressures. The body attempts to compensate with peripheral vasoconstriction. Skin may start to look pale and be cool to the touch. The patient may exhibit slight changes in behavior. Volume resuscitation with crystalloids (Saline solution or Lactated Ringer's solution) is all that is typically required. Blood transfusion is not typically required.

3. Class III Hemorrhage involves loss of 30-40% of circulating blood volume. The patient's blood pressure drops, the heart rate increases, peripheral hypoperfusion (shock), such as capillary refill worsens, and the mental status worsens. Fluid resuscitation with crystalloid and blood transfusion are usually necessary.

4. Class IV Hemorrhage involves loss of >40% of circulating blood volume. The limit of the body's compensation is reached and aggressive resuscitation is required to prevent death

Severe bleeding involves loss of large amount of blood which may occur externally through natural openings, like mouth. A cut on the skin too can lead to bleeding. Internal bleeding occurs due to an injury to blood vessel

   Causes

    1. Accidents/Falls

    2. Blow to the head

    3. Injuries, like scalp wounds

    4. Tooth Extraction

    5. Certain medications

    6. Illnesses like

      a. Hemophilia

      b. Scurvy

      c. Cancer

      d. Thrombocytopenia

      e. A plastic Anemia

      f.  Leukemia

      g. Hemorrhage

      h. Peptic Ulcer

      i.  Platelet Disorder

      j.  Liver Disease

      k. Septicemia

    Symptoms

1.         Discharge of blood from a wound

2.         Bruising

3.         Blood in stool/urine

4.         Blood coming from other areas, like mouth/ear

   Treatment

1.         Wash hands well before administering to patient

2.         Wear synthetic gloves

3.         Make the victim lie down

4.         Slightly elevate the legs

5.         If possible keep the affected area elevated

6.         Remove any obvious debris/particle

7.         Apply direct pressure using clean cloth/bandage

8.         Use hand if cloth is not available

9.         Apply pressure continuously for at least 20 minutes

10.    Do not remove the cloth to check the bleeding

11.    Hold the bandage in place using an adhesive tape

12.    If bleeding seeps through bandage, do not remove it

13.    Add extra bandage on top of the first one

14.    Apply direct pressure on the artery if necessary

15.    The pressure points for arm--below arm- pit/above elbow

16.    For leg--behind knee/near groin

17.    Squeeze the artery keeping finger flat

18.    Continue applying pressure on the wound

19.    Once bleeding stops immobilize the affected part

20.    See a doctor

   Consult a doctor if;

1.         bleeding does not stop

2.         bleeding occurs through nose, ears etc

3.         Coughing up blood

4.         Vomiting

5.         Bruising/deep wounds

6.         Abdominal tenderness

7.         Fracture

8.         Shock

   Steps To Avoid

1.         Do not try to replace a displaced organ

2.         Just cover the wound with a clean cloth

3.         Do not try to remove an embedded object

REFERENCES

1.     Severe Bleeding - First Aid and Emergency Treatment Guide | Medindia http://www.medindia.net/patients/Firstaid_SevereBleeding.htm#ixzz1tzehUnR4.

2.     "Bleeding Health Article". Healthline. http://www.healthline.com/adamcontent/bleeding. Retrieved 2007-06-18.

3.     "Dictionary Definitions of Exsanguination". Reference.com. http://dictionary.reference.com/browse/exsanguination. Retrieved 2007-06-18.

4.     "Blood Donation Information". UK National Blood Service. Archived from the original on 2007-09-28. http://web.archive.org/web/20070928035216/http://www.blood.co.uk/pages/b36faint.html. Retrieved 2007-06-18.

5.     Manning, JE "Fluid and Blood Resuscitation" in Emergency Medicine: A Comprehensive Study Guide. JE Tintinalli Ed. McGraw-Hill: New York 2004. p227

6.     Webert KE, Cook RJ, Sigouin CS, et al. The risk of bleeding in thrombocytopenic patients with acute myeloid leukemia. haematologica 2006;91:1530-1537

7.      Liberty G, Hyman JH, Eldar-Geva T, Latinsky B, Gal M, Margalioth EJ (December 2008). "Ovarian hemorrhage after transvaginal ultrasonographically guided oocyte aspiration: a potentially catastrophic and not so rare complication among lean patients with polycystic ovary syndrome". Fertil. Steril. 93 (3): 874–879. doi:10.1016/j.fertnstert.2008.10.028. PMID 19064264.