In my opinion, internal bleeding is one of the most frightening injuries you can be inflicted with. Much like cancer, internal bleeding often displays its nastier symptoms a good length of time after it has set in, creating an unfortunate ticking time bomb situation. The most common way to get internal bleeding is obvious – typically you will only ever end up with it by suffering some sort of traumatic impact to your body – in day-to-day terms, by being in a car accident or some other type of high-impact accident. While it’s very unlikely, internal bleeding can also occur without any injury to the body – though usually only as a byproduct of specific medical conditions, or reactions to particular prescription medications (more on this later). But typically, the time you should suspect you may have internal bleeding is right after some kind of high-impact collision or accident.
Needless to say, internal bleeding is a serious problem, so while we should all be crossing our fingers wishing that we won’t ever get into a car accident that leaves us with any type of internal bleeding in the future, let’s address the issue head on in the meantime, and dish out some advice that hopefully will be very handy in potentially helping you or those around you in the case that an unlucky hand gets dealt and you’ll have to deal with some type of internal bleeding.
The Groundwork: What is internal bleeding?
Internal bleeding (medical term: internal hemorrhaging) is exactly what you’d think it is based on its name – it is when you bleed inside your body. Internal bleeding is when bleeding takes place in the vascular system. It can occur within tissue, organs, or cavities of the body, and can honestly crop up pretty much anywhere. Internal bleeding is extremely dangerous if it occurs in the brain, lungs, and stomach, but regardless of if it happens to be elsewhere, it can still lead to life-threatening conditions and should be addressed immediately.
Internal bleeding can be caused in many different ways, but essentially it all boils down to damage being done to a vein or artery which ends up in blood escaping and collecting inside the body. The amount of blood that may pool up varies depending on the injury. The severity of internal bleeding also varies greatly depending on how well the body reacts by creating a first line of defense. The body can do a number of things to help out in the case of internal bleeding, including repairing the damaged blood vessels, allowing blood vessel spasms to temper the flow of blood, and helping blood clots to form in order to slow the bleeding and (ideally) eventually stop it.
When should I suspect I have internal bleeding?
You should suspect internal bleeding may be taking place when faced with severe injuries. If you’ve recently suffered a fracture of the skull, a fracture of a long bone that shows extreme swelling, or if you’ve had blows to the abdomen – you should begin to suspect you may also have internal bleeding. If you suspect there may be internal bleeding near your spleen or liver, take this extremely seriously. If internal bleeding occurs near these organs, you can expect signs of shock to develop.
Scroll down to the “How can I get internal bleeding?” section to read more on this topic.
What puts me at higher risk with regards to internal bleeding?
You should also be aware that if you are on blood-thinning or anti-clotting medication (which is very common – Aspirin is a blood thinner, for example) you are at a higher risk from what would otherwise be a minor case of internal bleeding. Something to think about if you are on Warfarin (or any other anticoagulation medication) or regularly take Aspirin (which is an anti-platelet medication).
You can also be born with a genetic conditions that impair the blood clotting system from operating optimally. Haemophilia and Von Willebrand disease are two common examples of genetic clotting disorders, but if you have them, you likely would have already been diagnosed young and your family doctor would have no doubt debriefed you about the risks associated with these conditions. I’ll not touch on the specifics with regards to these conditions, but if you’re curious, you can read up on Haemophilia and Von Willebrand disease on Wikipedia!
How can I get internal bleeding?
While there are four categories of ways you can get internal bleeding, the most common ways to get internal bleeding in day to day life occur, as stated before, in emergency situations where there has been a high-impact collision or accident. In an emergency situation, if you incur internal bleeding it will be from one of first three out of these four ways to potentially end up with internal bleeding –
1. Deceleration Trauma
Think Top Gun levels of deceleration here. Deceleration at very high speeds can cause the organs to shift around the body which can then shear blood vessels away from the organs creating a perfect storm for intracranial bleeding. Any force applied to the head in particular causes acceleration and deceleration to occur by virtue of the brain essentially bouncing around your skull (yes, not the most medical descriptor ever, but you definitely get the point)
Deceleration trauma is also common in the abdominal cavity as the pedicle can shear off from the arteries and veins causing the blood vessels to tear, and thus causing bleeding.
2. Blunt Trauma
If enough compression occurs to the internal organs, this can cause serious injuries and bleeding. This happens when involved in accidents that can inflict a powerful directional force, like falling or being hit by a car in a collision. If an organ (especially the spleen or liver) is struck resulting in a high degree of compression, the lining of the organ can tear. This will cause bleeding which will then settle in the space of your abdominal cavity (called the peritoneum).
The same process applies with injuries that are a result of crushing impact, like a heavy weight falling on a limb. When your body is stuck between a heavy object and the ground (for instance) the force has nowhere to go, resulting in bones breaking or muscle fibres tearing apart, and thus bleeding.
Another potential source of internal bleeding that’s not often thought about. Your bones contain bone marrow, and bone marrow produces blood. During a fracture, a significant amount of blood can be lost, especially with long bones like the femur. It’s rare for bones like the pelvis to fracture and thus result in massive bleeding, but it is possible so it’s worth noting. With that said, if your pelvis is fractured – you have been in a serious injury and will have need of medical assistance as a direct consequence. No way are you walking that off without noticing!
4. Pregnancy, surgeries, medication, and alcohol abuse
The other ways to get internal bleeding are either spontaneous (how horrifying), as a result of taking anti-coagulants, as a result of inherited genetic disorders that inhibit blood clotting, or after a surgery. It is also possible to get internal bleeding from anti-inflammatory drugs like ibuprofen and alcohol, especially in the esophagus, but it’s internal bleeding in this case is generally a consequence of alcohol abuse (especially in the case of alcohol causing liver damage).
Lastly, you can bleed during a pregnancy, which can indicate a miscarriage or other problems. Any bleeding during a pregnancy is not normal and you should go straight to emergency (forgo your family physician) to have them access if its placenta abruption (although with the amount of pain you will have, I don’t think I’d have to tell you to seek medical help!) or some other issue.
Symptoms of internal bleeding
- You can recognize internal bleeding from visible symptoms like blood being discharged from your ear canal or your nose; it may also present itself from bloodshot or black eyes when injuries to your head occur.
- Rust red or brown urine are often an indication of bleeding in the bladder or kidneys.
- Black or bloody stool from bleeding in the upper or lower bowels respectively.
- Bright red vomit if it’s a recent bleeding from your stomach or gritty, granular texture and brown if the bleeding has been in your stomach for sometime.
- Lastly, if you cough up red spotty/frothy blood it can be as a result of chest injuries that have caused internal bleeding.
By definition, internal bleeding is well, internal. Eventually symptoms may occur if enough build up of blood has happened which can cause;
- Large deep purple patches to appear on your skin.
- Swelling or tightness on your thighs as a result of fractures.
- Abdominal pain and/or swelling as a result of liver or spleen trauma. The pain is progressive as the bleeding continues. You won’t be in the mindset to read this if you have this problem.
- Headaches and loss of consciousness from brain bleeds.
- General light-headedness, dizziness, and fainting as a result of blood loss from internal bleeding.
Can I feel internal bleeding?
Now before you check your body for purple patches, be aware that in the vast majority of cases your body will let you know through pain that something is wrong. Hollywood has popularized this idea that walking down the street and then collapsing from a brain bleed (out of nowhere) is common but reality begs to differ; if you have a brain bleed, either you or anyone near you will reach for 911, because the pain will make it evident.
This is what happens, again, in most cases but just in case you (or I) happen to be extremely unlucky, let’s see what we should do should do (or tell someone to do if it’s not us) in this kind of a situation.
What can I do if I suspect I have internal bleeding?
If you or someone around you suspects they have internal bleeding do the following –
- Call 911. Be sure to tell them that the person has internal bleeding in particular.
- Minimize shock; have the casualty at complete rest with the legs elevated by 15-30 cm, the size of a standard ruler (or a little less) basically.
- Place casualty in the recovery position.
- Inform casualty not to move. Like, at all.
- Loosen tight clothing (if possible) around the chest, neck, and waist.
- Keep the temperature of the casualty steady; no extreme heat or cold.
- Give the casualty nothing by mouth; nothing.
- Reassure the casualty; tell him/her to keep as calm as possible, both mentally and physically. Relaxing is the best thing he/she can do in such a situation
You cannot (should not) do anything else, your job is to stabilize, not to treat. Wait for medical staff and once they arrive be a good first responder by telling the medical staff as much information as you can such as;
- If vomiting, uncontrolled urination, or bowel movements occurred. This is not about the victim’s dignity, but rather his or her life, so don’t spare details. You don’t know what could be a symptom or what could help the physician.
- The general temperature of the victim and what you did to maintain it.
- Quality of the breathing and the victim’s pulse. If the breathing is irregular in anyway, and if the pulse is weak or full.
- Any changes in the victim’s appearance, condition or any details that you think could be pertinent.
On major exception would be in the case of a fracture of the skull. Should there be bleeding of the ears accompanied with a yellow fluid you will want to first of all not stop the flow of blood (or any fluids) – I know this sounds like terrible advice but it’s important. Don’t place gauze or anything else inside the ear canal. Instead attempt to get professional help ASAP and;
- Apply a cervical collar if you have one (note: as LibertarianRN pointed out in the comments, learn how to put one of these on properly before you attempt doing this in an emergency situation; otherwise it’s best to skip this altogether); if not, try to keep the neck still and do what you can to minimize movement when at step 3.
- Loosely apply a dressing over the ear.
- Place the victim on the injured side, upped body slightly raised, all the while supporting the head and neck.
- Check breathing and general appearance at regular intervals.
- Try and help with shock (this is a whole other article, which I will get to eventually).
That’s all you can do for the most part. Internal bleeding is definitely not something you can actively go out and fix yourself. It’s important to reach out for help, and as you can tell, in general get the victim to relax as much as physically possible. It will greatly improve your chances of getting that person to the hospital in time.
A final word of caution
Do not try to move someone far or drive them to the hospital yourself if they have internal bleeding, unless of course you have no alternate recourse. In an ideal situation, let the professionals handle moving the individual under duress themselves. It will be much safer, considering bumps and jolts along the road may make the situation worse.
Get the victim to relax and call for help. It’s the best you can possibly do.
I hope the following information proves informative, I know that a lot of it is very passive but at the end of the day, internal bleeding is something that does happen in accidents and other traumatic events and whilst we preppers tend to want to get in there and fix/help things, in those situations you will want to stabilize, be a good Samaritan and let the pro’s handle it. With internal bleeding, so much can go wrong that its best to do as little as possible as to not make the situation worse. Keeping calm and breathing is the best you can do in such a scenario.
More First Aid Resources
When it comes to first aid, you need two important things to help you on your quest to keep yourself and those around you safe & healthy: knowledge and (to a lesser extent) supplies. To tackle the prior, take a look through our list of the top 22 emergency & survival first aid books and grab those that you think will best help you gain the knowledge you’ll need. For the latter, take a look at our Ultimate First Aid Supplies List to see if there’s anything you should be adding to your at-home first aid supplies stockpile, or if there’s something you’ve forgotten to add to one of your first aid kits.
Do you know how to tell if a cut is infected, whether to use Advil, Tylenol, or Aspirin, and how to quickly assess and address emergency situations? Did you know you can superglue cuts and that Imodium is an excellent tool for survival?
Have some spare time? You can also quickly browse through first aid articles published on this blog, in case there’s anything valuable you’ve yet to learn on the topics we’ve written about.
Zero-Sum Survival says
As a medic in AFG I dealt with quite a few IH casualties. Most of them were from combat related mechanisms of injury like concussive blasts or ballistic hydrostatic shock, but the prognosis & treatment was typically the same as mentioned in your post. Another hallmark of IH is a steady drop in BP -especially if it is occurring in the pelvis which can hold several litres of blood without presenting any immediate symptoms such as abdominal distension or bruising. If you don’t have a blood pressure cuff or aren’t trained to use one, you can still repeatedly check the pulse in a favoured area such as the radial (inside wrist) pulse to see if it is getting weaker despite there being no open (bleeding) wounds found.. Another good spot is the dorsalis pedis just inside the ankle below the ankle bone. You want to check an area distal (away) from the heart because flood flow to and from those areas are almost always affected first when a circulatory incident such as a drop in BP occurs because the body will reroute blood supply to the organs and brain. Also, in some instances with IH in the abdominal and pelvis region the casualty may report the urge to urinate and/or defecate due to the internal pressure being exerted on the bowels and bladder. They should NOT be encouraged to push since it will only make room for more bleeding into the adjacent tissue and possible hasten the bleed from engaging damaged muscle groups. But if they do soil themselves then reassure them and remember to preserve their dignity by covering them (if not already in treating for shock). A really good article and while there is nothing medically that can be done without the proper resources, the person can be kept calm and comfortable so that their anxiety doesn’t exacerbate their condition in the meanwhile.
Thomas Xavier says
Great info mate (especially with the pushing angle, never considered needing to urinate as an issue), thanks for sharing.
Good job on your blog too- I have subscribed and added it to the SurvivalPulse newsletter. Keep it coming!
Donna Blades says
My husband just went thru blood clots three weeks in hospital anemia He was inhe hospital for three weeks. This article has really helped.
Thomas Xavier says
Glad the article helped Donna, I hope he is doing better!
Chuck Findlay says
I’ve got an MP3 talk by David Christopher (Herbalist ) and in it he said that cayenne controls (as in stops or greatly reduced bleeding of all kinds, including internal. You can bet I would take some if I thought I had any kind of bleeding. (wish I could share it, but it’s proprietary. But the link below has it as part of the Summer-of-Survival package.)
It also stops heart attacks (and likely strokes as they are nothing more then a heart attack of the brain) within seconds of taking it. A tablespoon stirred into a warm glass of water and drank is what he recommends. OK it’s going to be hot ( spicy-hot) but if you are bleeding to death, that seems to be a good trade off. I have over the last year used cayenne to stop bleeding on cuts and it does work. Yea it stings a bit, but so does Quick Clot, and cayenne is 1/20th the price. You can buy it at any store. It can also be bought in capsules at a health store, this way you can take it internally and not feel the heat. I have The Capsule Machine and make my own herbal capsules including cayenne.
While I would not forgo going to a hospital or calling 911, you can bet I would also take some cayenne if I was bleeding bad or had a heart attack. I keep some in a pill container (Wal-Mart sells these for .99 cents) on my key chain in my pocket. It’s part of my EDC.
I got the David Christopher MP3 talk from the Summer-of-Survival web site. Off and on for the last 2-years they have been doing a weekly survival talk with experts in various fields giving the talk. David Christopher’s was about First Aid Herbs. It alone was worth the cost of the program as it was / is life saving information.
Summer-of-Survival web site
Thomas Xavier says
Cayenne pepper definitely equalizes blood pressure and works with internal hemorrhage nicely as wells as helping with arthritis & assisting digestion. Great stuff.
frank eyna says
hi tnx for this info.and great work edition .i like to read your work .tnx.
Thomas Xavier says
Thanks Frank, glad to hear it!
Good article! One note on gastrointestinal bleeding – if you have red or black vomit or stool, think about what you have consumed recently. We had a toddler “vomiting blood”, who had actually had red cool-aid with lunch. Also, pepto bismol and iron supplements are two of the more common causes of black stool.
Also, if you haven’t been trained in applying a cervical collar, I would recommend not applying one. They’re hard to get in place without manipulating the neck quite a bit in the process – can cause more harm than good.
Elise Xavier says
Thanks for the advice; really helpful! Just edited the article to include your tip about the cervical collar.
Also regarding gastrointestinal bleeding, let me add that multi-day use of non-steroid anti-inflammatory drugs (NSAIDS) can cause it, ESPECIALLY if taken on an empty stomach. This includes over-the-counter ibuprofen (aka Motrin, Advil, etc.).
A common scenario might be — someone takes a tumble and is injured so that walking out won’t be possible until the injury heals. The person takes 2-3 Advil every 6 hours, but does not eat anything. The stomach/intestinal discomfort is mistaken for hunger pangs. On the third day the person begins to feel “shocky”. The next bowel movements are liquidy, and either deep purple or black, and tarry.