Haemorrhage

Definition
This is an escape of blood from the blood vessels and this may be internal or external.

Causes of Haemorrhage

It may occur due to one of the three causes:

1. Direct injury to the blood vessel wall as a result of a wound or surgical intervention.

2. Disease of the blood vessel wall. This may be caused by infection or malignancy.
3. Disease of the blood itself e.g. haemophillia. Haemophilia is a condition characterised by delay in
the coagulation time of blood, it is due to lack of a specific blood clotting factor in the blood which
is necessary for satisfactory clotting. This factor is known as anti-haemophillic factor.
Classification
Haemorrhage may be classified in different ways
1. According to its situation
2. According to its source
3. According to the time it occurred.
Situational of Haemorrhage
External Haemorrhage
In this instance, the blood escapes from the blood vessel into the surface of the body and can be seen.

Internal or Unseen Haemorrhage

In this type of haemorrhage, blood escapes from the blood vessels into a cavity or organ of the body or into
the tissues. The simplest example of this type of haemorrhage is a bruise or heamatoma. It is possible for an
internal to eventually become visible. If blood escapes from the alimentary tract, the person may eventually
vomit all the blood or if there is bleeding from the respiratory tract the person may eventually cough off the
blood.
Sources of Haemorrhage
Haemorrhage may be classified according to the type of blood vessel involved:

Arterial Bleeding

If an artery is severed, the blood will be:

a. Bright red in colour due to the presence of oxygen in the blood.

b. Spurting from the wound, each spurt coincides with the heart beat.
c. Escaping from that part of the wound nearest to the heart.
d. Escaping from the wound under great pressure.

Venous Bleeding

If a vein is severed, the blood will be:

1|Page
a. Dark red in colour, this is due to the small amount of oxygen present in the blood.
b. Flowing from the wound in a steady stream and will not be under great pressure.
c. Escaping from the part of the wound farthest away from the heart.

Capillary Bleeding

This occurs in superficial wounds, e.g. in a graze or a scrape and the blood will be:

a. Oozing from the wound.

b. Neither bright red nor dark-red in colour.
c. Welling up from all over the wound.

Time of Haemorrhage

This may occur at the time of injury or it may occur later.

1. Primary Haemorrhage

This occurs at the time of injury or operation or when the blood vessel has been damaged by disease.
2. Reactionary

It is important to note that up to 24hrs after an injury or operation, bleeding may commence again, this
bleeding is due to reaction of the body. If there had been a haemorrhage, nature employs strategies to
prevent serious loss of blood. These strategies include:

(a) The blood pressure is reduced resulting in diminished flow of blood to that part.
(b) A blood clot forms, these clots of blood vessels further limiting loss of blood.
(c) The blood vessel wall turns in to hold the clot in position and prevents further loss.

3 Secondary Haemorrhage

This type of haemorrhage seldom occurs but if it does, it takes place within seven to ten days. It is slow to
develop after the injury or operation and is often due to infection. It is extremely dangerous and shows the
important of keeping wound absolutely clean.

Types of Haemorrhage

1. Ante Partum Haemorrhage

This starts before labour and is associated with placenta previa and abruptio placenta.

2. Cerebral Haemorrhage

This is collection of blood in a cavity within the cranium, which may be extradural, subarytenoid or
cerebral.

2|Page
3. Post-Partum Haemorrhage (Primary)

This refers to bleeding that occurs between 12 and 24hrs of delivery which measures 500ml or more.

4. Secondary Post-Partum

This refers to excessive bleeding after 24hrs of delivery

Signs and Symptoms of Haemorrhage
The Skin
It becomes pale and white and feels cold and clammy to touch. This is due to the constriction of the
superficial blood vessels. Physiological adjustments are made to improve the blood supply to deeper more
vital organs such as brain, kidneys, heart and liver, because of this restricted blood supply also the
temperature becomes subnormal i.e. 35°C or 95°F.

The Pulse

This is rapid and weak. How rapid and weak, depends on the severity of the haemorrhage.

Respiration

This is unique and unmistakable and is described as “air hunger” (deep sign of respiratory). The patient is
signing and grasping for air.
Facial Expression
The patient, if conscious, will look anxious, afraid and will be restless. Effect on the Brain
Brain tissue may suffer hypoxia, due to the brain not receiving enough blood supply, the patient may show
or complain of the following signs and symptom.

a. Dimmed or blurred vision

b. Buzzing and ringing in the ears
c. Dilated pupils
d. Mental confussion

Thirst

The patient commonly complains of thirst. This is the reaction of the body to lost of fluid. During bleeding,
fluid is withdrawn from tissues into the blood stream resulting in dehydration...

First Aid Management

It is important for any first aid worker to recognize signs and symptom of haemorrhage.
Internal Haemorrhage

1) Lie patient flat either on the bed, floor or couch.

2) Reassure the patient since he/she will be anxious.
3) Lower the head of the bed. This will help flow of blood by gravity to the head thus prevent fainting
or unconsciousness.

3|Page
4) Undo tight clothing rounded neck, chest and waist. This will allow the patient to breath more easily
and prevent suffocation.
5) Contact a doctor as soon as possible for further treatment or pain management.
6) If signs and symptoms are severe, then get the patient to the hospital with minimum amount of
movement and handling.
7) Keep crowd away from patient.
8) Keep patient warm.

External Haemorrhage

The general care will be the same as the internal haemorrhage with the
following special emphasis.

2. Stop the bleeding.

3. Any open wound must be covered immediately with a clean dressing. This prevents infection.

4. Immobilise extremities to the bleeding if the part that is bleeding involved is a limb, it should be
raised as high as possible and maintain in that position. This limits the amount of blood flowing to
that part; thus reduces the amount of bleeding.

5. Apply firm pressure, this may be directly on the wound, using a pad and placing it over the wound
and bandaging it firmly into position. A pad can be made from any available material.

6. Digital pressure can be applied to the nearest artery known to supply the part.

7. Only at a last resort is a tourniquet applied:

(1) It must be tight enough.

(2) There must be a piece of material between the tourniquet and the skin.

(3) It must not be left on longer than 15 minutes.

(4) An indication of the presence of a tourniquet must be made obvious. This might be done by putting
the letter T and the time of application in the patient’s forehead.

Dangers Associated With the Application of Tourniquet

1. Damage nerves and muscles.

2. If it is not tight enough, it may only limit venous blood flow and may not stop arterial blood flow.

3. Damage the skin.

4. Death of the affected part if the tourniquet is kept on for longer

than 20 minutes.
4|Page
Pressure Points in the Body

These are points in the body when an artery passes superficially over a bone.

1. Temporal Artery

This artery supplies the side of head. The thumb or tip of fingers may be used to apply pressure here, by
placing it over the zygomatic process of the temporal bone. It is about one inch in front of the external
auditory meatus. The pressure here will stop bleeding on the superficial side of the scalp.

2. Facial Artery

This artery supplies the side of the face passing at the side of the jaw in front of the angle. The artery can be
pressed against the mandible thus, limiting the flow of blood to the face.

3. Brachial Artery

This artery supplies the arm, and passes down the inner aspect of the humerus just beside the inner border
of the Bicep muscles. It is easier done if the nurse stands behind the patient.

4. Radial Artery

This is the artery most commonly used for recording the pulse. Digital pressure can be applied by pressing
the fingers very firmly on the artery as it passes across the radius.
5. Femoral Artery

This is the main artery of the leg; it passes down the front of the groin. To compress it, the patient should be
lying down with the knee flexed, grasp the patient’s thigh with both hands placing both thumbs one on top
of the other in the centre fold of the groin.

5|Page