Haemorrhage: Causes, Types, Symptoms, & Critical Treatment.

By Peter Jumba

 Haemorrhage: Causes, Types, Symptoms, & Critical Treatment.



Bleeding through broken blood vessel/Google Images 



 Understand the different types of haemorrhage (arterial, venous, capillary, internal) and their causes. Learn to recognize the critical signs and symptoms, essential first-aid, and definitive medical and nursing treatments.


A haemorrhage (or hemorrhage) is the medical term for any type of excessive bleeding, which can be external (visible outside the body) or internal (inside the body). It results from damage to blood vessels and can range from minor to life-threatening. Prompt recognition and management are crucial to prevent serious complications like hemorrhagic or hypovolemic shock.


Causes of Haemorrhage:

Haemorrhage occurs when a blood vessel is damaged, allowing blood to leak out. Causes generally fall into three categories:

  • Trauma: The most common cause, resulting from injury that damages blood vessels.


  • External: Cuts (lacerations, incisions), scrapes (abrasions), puncture wounds, and amputations.


  • Internal: Blunt force trauma (e.g., from an accident or fall), crushing injuries, and penetrating wounds (e.g., gunshots, stabbings).


  • Medical Conditions: Underlying diseases can weaken blood vessels or impair clotting.


  • Blood disorders: Hemophilia, von Willebrand disease, and thrombocytopenia (low platelet count).


  • Vascular diseases: Aneurysms (weakened, bulging vessel walls) and vasculitis (blood vessel inflammation).


  • Other conditions: Peptic ulcer disease (gastrointestinal bleeding), certain cancers, liver failure, and high blood pressure (hypertension).


  • Medications: Drugs that interfere with the blood clotting process.


  • Anticoagulants (blood thinners) like warfarin or heparin.


  • Antiplatelet drugs like aspirin or clopidogrel.


Types of Haemorrhage:

Haemorrhages are classified based on the type of blood vessel damaged and the location of the bleeding.


Classification Description:

  • Arterial Bright red blood, spurting in rhythm with the heartbeat. This is the most dangerous due to high pressure and rapid blood loss.


  • Venous Dark red blood, flowing steadily. While less forceful than arterial, the blood loss can still be significant.


  • Capillary Slow, oozing or trickling of blood. Generally the least severe and often stops spontaneously.


  • External Visible bleeding outside the body through a break in the skin or a body orifice (e.g., nosebleed, cut).


  • Internal Bleeding that occurs inside the body, often into a body cavity (e.g., abdomen, chest, skull) or organ. This can be difficult to detect and is often life-threatening.


Signs and Symptoms:

Symptoms depend heavily on the location and amount of blood lost. Significant blood loss leads to hypovolemic shock, a life-threatening condition.

  • Mild/Moderate Bleeding (Early Signs) Severe Bleeding/Hypovolemic Shock Specific Internal Haemorrhage Signs.


  • External: Obvious bleeding, bruising (hematoma). Mental Status: Anxiety, agitation, confusion, loss of consciousness. Head/Brain: Sudden severe headache, confusion, weakness on one side of the body.


  • Systemic: Mild dizziness, weakness, fatigue. Circulation: Rapid and weak heart rate (tachycardia), low blood pressure (hypotension), cool and clammy skin, delayed capillary refill. Chest/Lungs (Hemothorax): Difficulty breathing, chest pain, coughing up blood.


  • Respiratory: Rapid, shallow breathing. Abdomen/GI Tract: Abdominal swelling or hardness, pain, bloody or black/tarry stools, vomiting blood.


  • Other: Extreme thirst, decreased urine output. Limb: Extreme swelling, tension, and pain (may indicate compartment syndrome).


Treatment Options:

The primary goals of treatment are to control the bleeding and restore lost volume to prevent shock.


Type of Haemorrhage Initial Treatment (First Aid) Definitive Medical Treatment.


External.

  • Apply direct, firm pressure to the wound with a clean cloth or gauze. Minor: Cleaning, bandaging, stitches, or surgical glue.


  • Elevate the injured limb above the heart, if possible and not causing further injury. Severe: Immediate surgery to ligate (tie off) or repair the damaged vessel; use of hemostatic agents.


  • For life-threatening extremity bleeding, a tourniquet may be necessary. For any significant haemorrhage:


Internal.

  • Call emergency services immediately.

 

  • Keep the patient warm and still.

 

  • Do not give anything by mouth.

 

  • Resuscitation: IV fluid administration (crystalloids/colloids) to maintain circulation.

 

  • Blood Transfusion (Packed Red Blood Cells, platelets, clotting factors) for massive blood loss.


  • Source Control: Imaging (CT, X-ray, Ultrasound) to locate the bleeding, followed by definitive intervention such as surgery (e.g., to repair a ruptured organ or vessel) or interventional radiology (e.g., embolization).


Nursing Considerations:

Nursing care is vital in the immediate and ongoing management of haemorrhage.


Monitoring and Assessment:

  • Frequent Vitals: Monitor blood pressure, heart rate, respiratory rate, and oxygen saturation every 5-15 minutes, or more often as indicated, to track for signs of shock.


  • Assess Bleeding: For external bleeding, monitor dressings for saturation. For internal bleeding, closely monitor abdominal girth, mental status, and input/output (e.g., decreased urine output is a critical sign).


  • Labs: Monitor hemoglobin, hematocrit, platelet count, and coagulation studies (PT/INR, PTT).


  • Mental Status: Assess for changes in level of consciousness, which can indicate poor brain perfusion.


Interventions and Support:

  • Maintain IV Access: Establish and maintain two large-bore IV catheters (14- to 18- gauge) for rapid fluid and blood product administration.


  • Fluid Resuscitation: Administer prescribed IV fluids and blood products rapidly using a rapid infuser, if necessary, while monitoring for fluid overload.


  • Airway and Breathing: Ensure a patent airway and provide supplemental oxygen as ordered.


  • Wound Care: Apply or assist with direct pressure, pressure dressings, or tourniquet application as appropriate, strictly following protocols.


  • Comfort and Positioning: Keep the patient warm (preventing hypothermia, which worsens clotting) and place them in the supine position (flat on their back) with legs elevated to promote blood return to the core (Trendelenburg position is often not recommended).


  • Patient and Family Support: Provide clear, calm updates and emotional support, as haemorrhage is a frightening experience. Prepare the patient for possible procedures (e.g., surgery, scans).

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