Bleeding can range from minor to severe, and being able to identify signs of life threatening bleeding is critical for administering prompt first aid or medical treatment. There are two key ways to tell if bleeding may be life threatening:
1. Amount of Blood Loss
The amount of blood loss is a major indicator of how serious the bleeding is. Here are some general guidelines:
- Minor bleeding – small cuts or scrapes that bleed a little bit of blood
- Moderate bleeding – deeper cuts that bleed steadily for a few minutes
- Severe bleeding – large, deep wounds or amputations that result in significant blood loss
- Life threatening bleeding – very rapid blood loss that can quickly lead to shock or death if not stopped
With life threatening bleeding, blood may be pouring or squirting out rapidly from a wound. Large puddles or pools of blood may form quickly. You may see soaked clothing or blood dripping or running down the body. Massive blood loss can occur internally as well after trauma.
As a general guideline, losing about 2 liters of blood is considered life threatening. For perspective, the average adult has around 5 liters of blood volume. Losing 20% or more of total blood volume can send the body into hypovolemic shock as blood pressure drops. Death can occur when over 40% of blood volume is lost.
2. Signs of Hypovolemic Shock
Hypovolemic shock is a life threatening condition that occurs with severe blood or fluid loss. The early signs include:
- Fast heart rate over 100 bpm
- Rapid breathing over 20 breaths per minute
- Pale, cold, clammy skin
- Delayed capillary refill (press on the fingernail bed and it takes over 2 seconds to return to pink)
- Feeling faint, dizzy, or weak
- Confusion or anxiety
- Nausea or vomiting
- Extreme thirst
As hypovolemic shock progresses due to uncontrolled bleeding, the later signs can include:
- Blue lips and fingernails
- Gasping for breath or hyperventilating
- No urine output
- Unconsciousness or coma
- Skin may become mottled or ashen
If you observe these signs of shock in someone with significant bleeding, it indicates a medical emergency requiring immediate treatment to prevent death. Call emergency services right away.
First Aid for Life Threatening Bleeding
If you encounter life threatening bleeding, quick first aid can help sustain life until medical care arrives. Follow these steps:
- Call 911 or emergency services. Have someone else make the call if possible.
- Lay the person down on their back and elevate the legs about 12 inches unless a spinal injury is suspected.
- Apply firm, direct pressure on the wound with a clean cloth, bandage, or your hand (wearing gloves if possible). Apply enough pressure to stop the bleeding.
- If bleeding soaks through the bandage, add more material on top and continue direct pressure. Do not lift bandages to check bleeding.
- If a limb is bleeding severely, apply a tourniquet several inches above the wound to stop blood flow. Use a belt or bandana wrapped tightly around the arm or leg. Note the time applied.
- Keep pressure on the wound until paramedics arrive. Do not remove bandages.
- Monitor breathing. Perform CPR if needed and you are trained.
- Keep the person warm but do not overheat.
- Treat for shock – lay them flat, elevate legs about 12 inches, and keep them warm. Do not give food or drink.
With traumatic injuries, do not remove embedded objects from wounds. Cover wounds with a bulky bandage and apply pressure around impaled objects. Also watch for heavy bleeding that may restart when EMS moves the person.
Seek medical help even for stopped bleeding, as delayed bleeding can occur later. Ongoing wound care and treatment for blood loss are needed. Call 911 or go to an emergency room for any severe, uncontrolled bleeding – it can quickly become life threatening.
Causes of Life Threatening Bleeding
Some common causes of major bleeding that can become life threatening include:
- Traumatic injuries – Deep lacerations, gunshot or stab wounds, amputations, internal organ damage from accidents
- Gastrointestinal bleeding – Ulcers, hemorrhoids, cancerous tumors
- Ruptured aortic aneurysm – Burst abdominal blood vessel
- Postpartum hemorrhage – Heavy bleeding after childbirth
- Gastrointestinal ulcer – Ruptured ulcer in stomach or intestines
- Trauma to head – Head injuries that damage blood vessels
- Bleeding disorders – Hemophilia, vitamin K deficiency, thrombocytopenia
Life threatening bleeding requires emergency medical care. Do not try to drive yourself or have someone drive you to the hospital with major bleeding – call an ambulance. Paramedics can provide care en route to help stabilize blood loss.
Internal Bleeding Symptoms
Bleeding may also occur internally after an injury, without any visible external wounds. Watch for these potential signs of internal bleeding:
- Dizziness, fainting, or loss of consciousness
- Rapid heart rate, palpitations
- Shortness of breath, difficulty breathing
- Abdominal swelling or distention
- Cool, clammy skin, paleness
- Nausea or vomiting blood
- Coughing up blood
- Blood in urine or stool
- Jaundice (yellowing skin and eyes)
- Chest, back, or pelvic pain
- Weakness, fatigue, lethargy
- Confusion
Seek immediate medical care if internal bleeding is suspected after an injury. Emergency surgery may be required to stop the source of bleeding.
How Emergency Rooms Treat Severe Bleeding
When someone with life threatening bleeding arrives at the emergency room, doctors take rapid steps to stabilize them, find the source of bleeding, and stop further blood loss. Treatment may include:
- IV fluids – To restore blood volume and increase low blood pressure
- Blood transfusion – Type O negative packed red blood cells
- Surgery – Repair injured blood vessels, stop internal bleeding
- Medications – Vasopressors increase blood pressure, Vitamin K to assist clotting
- Cauterization – Burning tissues to seal injured blood vessels
- Embolization – Blocking of blood supply to bleeding sites
- Wound packing – Packing a wound cavity with gauze to apply internal pressure
The person will be closely monitored in an intensive care unit after initial resuscitation. Bleeding complications can happen even after surgery to repair blood vessels or stop bleeding sites. Repeat surgeries may be needed to find and tie off bleeders.
Risk Factors for Life Threatening Bleeding
Some conditions that increase the risk of experiencing major or uncontrolled bleeding include:
- Taking blood thinners like warfarin, heparin, or aspirin
- Liver disease – reduces blood clotting proteins
- Kidney disease – reduces production of clotting factors
- Hemophilia or other inherited bleeding disorders
- Vitamin K deficiency
- Thrombocytopenia – Low platelet count
- Recent surgery or trauma
- Gastrointestinal ulcers
- Enlarged spleen – splenomegaly
Steps to prevent life threatening bleeding include closely monitoring patients at risk, avoiding trauma, managing underlying conditions, and reversing coagulation defects when possible before procedures.
Conclusion
Severe, life threatening bleeding requires immediate emergency medical care. Quick recognition of the signs of major blood loss and shock allows faster treatment and can help save lives. Controlling external bleeding with direct pressure and tourniquets buys critical time until surgical repair and transfusions can occur. Even after bleeding is stopped, ongoing monitoring and care is needed to stabilize the patient.
