Severe internal bleeding. How to recognize internal bleeding and what symptoms are typical for it

One of the most insidious acute life-threatening conditions is internal bleeding. They are a pathological condition accompanied by the release of blood from the vessels into the free abdominal cavity, retroperitoneal space or hollow organs (stomach and intestines). The whole complexity of the situation is that usually most diseases cause concern in a person in connection with the signaling pain syndrome. With any bleeding there are no such signs. This leaves this problem went unnoticed for a long time. They begin to pay attention to it only when the condition of patients sharply worsens. But there are specific symptoms internal bleeding, knowledge of which can help in timely diagnosis this complex problem.

Signs of internal bleeding

By paying close attention to all changes in the body, you can notice seemingly ordinary changes. Over time, they gradually worsen. Immediate signs of internal bleeding:

1. Feeling unwell and general weakness;
2. Dizziness and fainting;
3. Drowsiness and apathy (lack of interest in anything);
4. Unnatural pallor skin;
5. A decrease in blood pressure below those figures that are typical for a particular person in normal times ( arterial hypotension);
6. Increased heart rate (tachycardia).

All listed symptoms are considered general. They are typical for any type of internal bleeding. There is another group of clinical manifestations that relate to specific signs one or another type of this disease. About them we'll talk in other sections of the article.

The only thing worth focusing on is the speed of development and progression of symptoms. Sometimes all the signs grow so quickly and spontaneously that neither the patients themselves nor the people around them can understand what is happening. But it happens that the situation develops gradually with gradual disruption general condition and worsening symptoms. This option clinical course internal bleeding is more favorable, as it makes it possible to notice threatening symptoms and promptly seek help.

The intensity of internal bleeding and the rate of increase in its symptoms depend on the cause of its occurrence and the diameter of the bleeding vessels. The more large vessel damaged, the heavier it is!

Types of internal bleeding and their manifestations

If we consider this issue globally, we can say that internal bleeding is one in which the spilled blood does not have direct contact with the external environment. Therefore, many do not classify bleeding from the stomach and intestines as internal. But, if we take into account that they may not cause specific symptoms for a long time, then it is advisable to consider them in the context of internal ones. After all, the main thing is to suspect a problem as early as possible, and everything else will be clarified during the process of observation and diagnosis in a medical facility.

All types of internal bleeding and their corresponding specific symptoms are shown in a visual table.

Laparoscopy is the most modern method diagnosis and treatment of internal bleeding

Immediate causes

The following diseases and conditions can lead to internal bleeding:

1. Closed and open abdominal injuries with damage to internal organs (liver, spleen, mesentery of the small intestine);
2. Ovarian apoplexy (ovarian ruptures);
3. Rupture of an ovarian or pelvic cyst (most often occurs during sexual intercourse);
4. Active physical activity (can provoke ruptures of cystic ovaries or enlarged internal organs);
5. Injuries of the lumbar region;
6. Aortic aneurysms that begin to dissect;
7. Peptic ulcer duodenum and stomach;
8. Ruptures of the mucous membrane of the esophagus (Malory-Weiss syndrome);
9. and stomach;
10. Decaying tumors gastrointestinal tract, abdominal cavity and retroperitoneal space.

There can never be internal bleeding independent disease. They are always either the main manifestation or a complication of a number of pathological conditions.

What is the danger and what to do

It is very important to know how to behave correctly in case of internal bleeding. After all, a person’s life often depends on it. Undifferentiated tactics boil down to the following activities:

1. Lay the patient down with the slightest signs internal bleeding. All further actions must be carried out in a strictly horizontal position of the patient;
2. Cooling the abdomen (ice pack or cold heating pad on the lower abdomen, hypochondrium or lumbar region, depending on the presumed location of the source of bleeding);
3. Transport the patient in this position to the nearest medical facility.

If you neglect the rules of first aid, this can lead to increased bleeding and massive blood loss. Such conditions are always very dangerous and pose a direct threat to human life.

In a surgical hospital setting, specialists can choose the following tactics.

In the vast majority of cases of internal bleeding, emergency treatment is required. surgical treatment. This is the only way to save lives and prevent complications.

Internal bleeding is a pathological process in which blood from damaged blood vessels flows into internal organs or artificially formed spaces. It is impossible to visualize this state, and initial stages patients rarely feel any changes in their health.

Complaints arise when blood loss reaches impressive proportions. Lack of treatment often leads to the death of the patient.

Types of internal bleeding in medical practice

In modern medical science there is no unified classification internal bleeding.

The phenomenon under consideration, depending on certain characteristics, can be divided as follows:

1. Based on the reason that provoked the bleeding:

1. Mechanical . This type of bleeding occurs when blood vessels are injured, which can occur due to blows, or as a result of surgery.
2. Arrosive . It is the result of necrotic processes that affect blood vessels, or develops against the background of germination and decay of pathological neoplasms.
3. Diapedetic . With this bleeding, the walls of the blood vessels are not destroyed, but due to various ailments ( hemorrhagic vasculitis, scurvy, phosphorus poisoning, etc.) capillary permeability increases.

2. Depending on the type of vessel that is bleeding:

1. Arterial . The doctor diagnoses damage to the integrity of the artery wall.
2. Venous . Occurs when a vein is damaged.
3. Capillary . In such situations, blood oozes evenly from the capillaries. If the outpouring of blood occurs from the capillaries of some internal organ, they speak of parenchymal bleeding .
4. Mixed . This type of bleeding occurs as a result of simultaneous damage to veins, arteries, and capillaries.

3. Taking into account the location of the bleeding:

4. Based on the area of ​​blood accumulation:

1. Cavity . In turn, they are divided into bleeding in the peritoneal cavity (with injuries to the abdomen, chest, internal organs), pleura (with rib fractures), and skull.
2. Interstitial . Blood accumulates in the thickness of the tissues, which leads to their separation and the formation of hematomas.

5. Depending on the amount of blood lost:

1. Light bleeding . Total losses amount to no more than 15% of the total circulating blood volume (CBV).
2. Average . Blood loss reaches 20% of the total blood volume.
3. Heavy . Due to bleeding, the victim lost about 1500 ml. blood (24-30% of bcc).
4. Massive . The total volume of circulating blood decreased by more than 30%.
5. Lethal . Blood loss exceeds 60% of the total blood volume.

6. Considering the nature of bleeding:

1. Explicit . Over time, blood leaks out through various natural openings of the victim.
2. Hidden . Clinical manifestations absent or weakly expressed.

7. Depending on the moment of bleeding:

1. Primary . They make themselves felt immediately after the wall of a blood vessel ruptures.
2. Secondary . It appears after a certain period of time after injury. This type of bleeding is divided into two subtypes:
3. Secondary early. They appear after 1-3 days due to the release of a blood clot from the affected vessel or when a ligature suture is applied incorrectly.
4. Secondary late. Fixed at least 3 days after damage to the vessel as a result of infection of the wound surface.

The main causes of internal bleeding - what factors can provoke them?

The pathology in question is often provoked by the following phenomena:

Signs and Symptoms of Internal Bleeding in Humans – How to Identify Internal Bleeding?

The symptoms of this pathology will be determined by the degree of its severity.

However, there are a number of general signs that suggest the development of internal bleeding in a patient :

1. Paleness of the skin.
2. Loss of strength due to low blood pressure.
3. Dizziness, dark “stars” before the eyes.
4. Tachycardia.
5. Dry mouth, increased feeling of thirst.
6. Cold sweat.

Signs of internal bleeding, taking into account its severity, are as follows:

For light bleeding characterized by a slight increase in heart rate and decreased blood pressure.

But often there are no manifestations.

For blood loss moderate severity the following symptoms occur:

• Decrease in systolic pressure to 80 mm. rt. Art.
• Promotion heart rate up to 100 beats per minute.
• Upper and lower limbs become cold.
• The skin turns pale.

Heavy bleeding has the following symptoms:

• The skin becomes bluish in color. On general background The area of ​​the nasolabial triangle is highlighted.
• The patient constantly wants to sleep.
• Blood pressure drops and heart rate increases.
• Tremor is recorded upper limbs.
• Sometimes nausea and vomiting may be present.
• Urinary excretion occurs very rarely.
• The patient does not react to what is happening around him.

With massive blood loss, the following phenomena are recorded:

• Blood pressure drops to 60 mmHg.
• The pulse increases to 160 beats per minute.
• Consciousness is absent or confused.
• Sharply expressed dark circles under the eyes.
• Cold sticky sweat.
• The eyes are sunken.

In case of fatal blood loss, the patient falls into a coma. His blood pressure is often undetectable, he is unable to hold urine and feces. The pupils dilate greatly, the pulse cannot be felt.

This condition leads to agony and death.

Typical sign bleeding in the gastrointestinal tract - vomit Brown and/or the presence of blood in the stool.

If the color of the stool turns bright red, this may indicate bleeding in the lower parts of the large intestine, hemorrhoids. Also recorded painful sensations in the abdominal cavity, which decrease with changes in body position. Palpation of the abdomen is accompanied by painful sensations.

When blood is localized in the lungs The patient coughs frequently, coughing up a foamy red consistency. If blood leaks into the pleural cavity, it is difficult for the patient to breathe.

Modern diagnosis of internal bleeding

The pathology in question can be diagnosed by performing several activities:

1. Measurement of blood pressure and pulse. As noted above, bleeding of any degree is accompanied by deviations from the norm in these indicators.
2. Palpation of the abdominal cavity. It is carried out with a change in the position of the patient’s body.
3. Laboratory tests of blood, feces, vomit (if any).
4. Rectal examination; Probing of the stomach: necessary in case of malfunctions of the gastrointestinal tract.
5. Bronchoscopy is used in cases where the patient’s medical history contains information about diseases respiratory system or in case of injury chest.
6. Cystoscopy is prescribed for errors in the functioning of the urinary system.
7. To exclude/confirm bleeding in the abdominal cavity, laparoscopy is used.
8. X-ray of the skull and echoencephalography help to detect hemorrhage in the brain.
9. Women should mandatory undergo an examination by a gynecologist.

In general, if the doctor has enough time in the patient's situation, he can spend additional ultrasound examinations, radiography etc.

Internal bleeding is blood loss inside the human body, where blood flows into cavitary structures of natural origin (gastric, pulmonary, renal and various other cavities) or into subspaces of artificial origin (retroperitoneal type of space, spaces between muscles and other areas). Internal bleeding is not available for observation; in the first stages of blood loss, the patient will not always feel signs of internal bleeding, he will feel as usual. The patient complains when hemorrhagic conditions have reached critical limits.

If there is no treatment for internal bleeding, death is possible. Symptoms of internal bleeding depend on the location and size of the hemorrhage. Often, symptoms of internal bleeding include general character.

About the types of hemorrhagic conditions

In medicine, the internal type of hemorrhage is not classified in detail. Based on the cause of internal bleeding, there are the following types:

• Mechanical type. This condition occurs in the event of trauma to the vascular tissues through which blood flows. Occurs due to injury (often occurs in men) or due to surgery.
• The arrosive type of hemorrhage is considered to be a consequence of necrosis affecting vascular tissue or if newly formed structures grow and disintegrate.
• Diapedetic type. At this state vascular tissue is not subject to destruction, but due to various pathological processes(hemorrhagic vasculitic changes, phosphorus poisoning and many other processes), the capillary network becomes highly permeable.

According to the type of vascular tissue there are:

• Arterial type, where destruction of the arterial vessel is diagnosed.
• Venous type, in which the veins are damaged.
• Capillary type. The blood medium spreads evenly from the capillary vessels. If blood comes out different organs, then this is a parenchymal type of hemorrhage.
• Mixed type. Occurs with destructive changes in venous, arterial and capillary vessels.

If we take into account localization, then there are:

• Gastric and intestinal species hemorrhages. Possible due to ulcerative processes in the stomach and duodenum, gastritis changes, inflammation of the intestines, also if the mucous membrane is cracked and there are newly formed structures. If esophageal hemorrhages are observed, the cause is liver dysfunction. In case of intestinal hemorrhages or intraperitoneal bleeding, the cause is hemorrhoidal changes or rectal fissures.
• Hemorrhages localized in the cavity spaces of the pleura due to torn vascular tissues between the ribs (hemothorax). This condition occurs when there is a closed injury to the chest.
• Hemorrhages that flow into the pericardium (pericardial sac), which compresses the heart muscle (hemipericardium). If this condition is ignored, it can manifest itself as heart failure followed by death. Such hemorrhage can occur with a mechanically damaged chest in the front, surgical intervention on the heart muscle.
• Intra-articular hemorrhages (hemarthrosis). Often manifests itself this type bleeding due to damage to articular tissues (usually knee joints).

According to the location where blood accumulates, there are:

• Hemorrhages in cavities. They are divided into bleeding of the abdominal cavity (if the abdominal area, chest and various organs are injured), pleural membrane (if the ribs are broken), cranium.
• Hemorrhages inside tissue structures where blood accumulates in deep tissues, which stratify, causing hematoma formations.

According to the amount of blood loss there are:

• Mild hemorrhages, where total blood loss is no more than 15% of the total blood circulation.
• Moderately severe hemorrhagic conditions, where blood is lost 20% of the total blood circulation.
• Severe bleeding, where the patient has lost approximately 1.5 liters of blood
• Massively manifested hemorrhagic condition. The total volume of blood circulation is reduced by more than 30%.
• Fatal blood loss occurs when the total circulating blood volume decreases above 60%.

Hemorrhages can occur:

• Obviously. After a certain time, the blood comes out external environment through the patient’s natural type of orifices.
• Is hidden. Main symptomatic manifestations not observed, perhaps they manifest themselves weakly.

Given the time period, there are:

• Primary identified blood loss. Signal about themselves after vascular wall torn.
• Secondary detected hemorrhages. They are observed a certain time after the traumatic factor that provoked them. This type of hemorrhage is divided into early, where manifestations occur after a period of 1 to 3 days due to the fact that an embolus has come out of damaged vascular tissue or the suture has been incorrectly applied. Late, secondarily detected hemorrhages appear three days after the vessel is damaged as a result of infection joining the wound.

About the reasons

The following circumstances are typical for internal bleeding:

• As a result of a head injury, a cerebral type of hemorrhage occurs.
• Rib fractures, both multiple and single, where arterial vessels between the ribs and the pleural membrane.
• Severe injury abdominal area, leading to the destruction of organs located in the abdominal area, which will cause intra-abdominal bleeding.
• Intra-articular tissues are fractured. These hemorrhages are not dangerous, but treatment must be carried out, otherwise aggravated conditions will arise.
• Severe dysfunction of the stomach and intestines in the form of ulcerative processes, malignant tumors, which will cause bleeding into the abdominal cavity.
• Cirrhotic changes in the liver also contribute to the fact that the patient may experience intra-abdominal bleeding.
• An aneurysmal vascular change that causes the aorta to dissect.
• The presence of esophageal cracks in the mucous tissue.
• Defective conditions of the reproductive system: cystic and polyposis changes. Strengthened mode physical activity, active species sports contribute to the rupture of the cyst. Hemorrhages can be due to the fact that the pregnancy occurs outside the uterus, in case of abortion, premature placental abruption, or the placenta is retained upon delivery. Sometimes women experience bleeding after childbirth.

About the symptoms of hemorrhages

Symptomatic picture hemorrhagic conditions determined by the stage of the pathology. With this diagnosis, there is a general pattern of symptoms that determine the presence of internal hemorrhages, including intra-abdominal bleeding. This condition can be recognized by the symptoms that caused hemorrhage:

• Pale skin tone.
• General weakness of the patient with low blood pressure.
• The patient will also feel dizzy and will see characteristic dark spots.
• Increased heart rate.
• Dry condition oral cavity, the patient will also be very thirsty.
• Cold sticky sweat sick.

When bleeding into the abdominal cavity, the symptoms correspond to general manifestations described above. At different degrees severity, the following occurs: with mild hemorrhage, the heart rate is slightly increased, blood pressure is reduced.

Other conditions do not appear.

Moderately severe hemorrhage is characterized by:

• Reduced systolic blood pressure to 80-81 mm Hg. Art.
• Increased heart rate up to 100-101 beats per 1 minute.
• Hands and feet are cooled.
• The skin is pale.

Severe hemorrhages are manifested by:

• Patient's skin bluish tint. The nasolabial zone with a characteristic triangle is clearly visible.
• The patient constantly wants to fall asleep.
• There is trembling in the hands.
• Sometimes the patient may feel nauseous and vomit.
• The patient rarely urinates.
• The patient has no reaction to the environment.

Massively occurring hemorrhage is characterized by the fact that:

• Blood pressure is 60-61 mm Hg. Art.
• The pulsation is increased to 159-160 beats per 1 minute.
• Conscious activity is absent or confused.
• Under each eye there is a pronounced circle of a dark shade, the eyes are sunken.
• The patient becomes covered in cold, sticky sweat.

Mortally severe hemorrhage is characterized by the fact that the patient is in comatose. Blood pressure cannot be determined; defecation and urination are uncontrolled. Each pupil is greatly dilated, the pulsation cannot be felt.

It is important to understand that this leads to an agonal state and fatal outcome sick.

How to determine internal bleeding? If hemorrhages are localized in the stomach and intestines, then the patient vomits brown vomit, and blood is also present in the stool. This may indicate that the patient has intra-abdominal bleeding.

When the stool has a rich red tint, it is likely that the patient has hemorrhages of the lower segments of the intestinal tract and hemorrhoidal processes. Bleeding into the abdominal cavity (intra-abdominal) is also possible, which causes pain in this area, which decreases when the patient’s position changes. Palpation of the abdominal area also revealed pain.

About diagnostics

When diagnosing internal bleeding, the following procedures are performed:

• Blood pressure levels are measured with pulse. For various hemorrhagic conditions, also if the patient has bleeding into the abdominal cavity, then these parameters will change from normal.
• Palpation examination of the abdominal area is performed with a changed position of the patient's body.
• Diagnosis is made in the laboratory using vomit (if present), feces, and blood.
• Perform rectal diagnostics. The stomach is probed, which is required for dysfunction of the stomach and intestines.
• A bronchoscopic examination is performed if the patient has pathological conditions of the body system responsible for breathing or with chest injuries.
• Cytoscopic examination is performed for dysfunction of the urinary system.
• To obtain confirmation or refutation indicating that the patient has bleeding into the abdominal cavity, a laparoscopic examination is performed.
• X-ray examination of the skull is performed for cerebral hemorrhages.
• A woman needs a gynecological examination.

Why is it dangerous and how to help the patient

How to provide first aid? In case of internal bleeding, first aid must be carried out immediately. Proper first aid for internal bleeding will save human life, you will learn the order of actions.

How to stop internal bleeding, what to do? Stopping internal bleeding consists of the following steps:

• When internal bleeding is suspected, emergency care must be provided to the patient, who should lie horizontally.
• Performance emergency care in case of internal bleeding, if there is a suspicion that the patient is bleeding into the abdominal cavity, it is necessary to cool the abdominal area (put a bubble with pieces of ice inside or a cooled heating pad on the lower part of the abdominal area, hypochondrium and lower back, which depends on the location hemorrhages);
• We need to call an ambulance, call it quickly. The patient is transported in the same position in which he was given first aid to the hospital. This must be done immediately.

This is dangerous and threatens human life.

IN surgical department The patient is prescribed therapeutic measures:

• For minor hemorrhages with moderate blood loss, stopped on their own, if there are no severe injuries and blood does not accumulate in the abdominal cavity, then the patient is observed. The main measures are that solutions containing salt are administered intravenously. They are treated with Ringer, Rheosorbilact, Refortan, saline solution. Among hemostatic agents, they are treated with Etamsylate, aminocaproic acid. This is how this blood loss is stopped.
• In severe hemorrhagic conditions of any nature, regardless of the underlying cause and damage to internal organs, the patient is urgently operated on with infusion therapeutic measures.

It is worth remembering that this type of hemorrhagic condition requires immediate therapeutic measures. If the moment is missed, the person will die.

In contact with

Since injury, and therefore bleeding due to it, can happen anywhere and anytime, every adult should know how to provide first aid for bleeding.

Types of bleeding and their features

Depending on the type of injured vessel, the following types of bleeding are distinguished:

• Arterial;
• Venous;
• Capillary.

Bleeding is also differentiated by location. The hands are most often injured - bleeding of the upper extremities is the most common type. In second place are leg injuries, and in third place are nosebleeds. The most dangerous type is bleeding of internal organs, since they are difficult to notice in time, and even more difficult to keep the situation under control. Below we will look at the principles of first aid for arterial, venous, nasal and internal bleeding.

First aid for arterial and venous bleeding

Many people vaguely remember that first aid for arterial bleeding consists of applying a tourniquet to the vessel, but few people know how to do it correctly. Doctors warn: applying a tourniquet can be no less dangerous than loss of blood; an ineptly applied tourniquet can lead to the need for amputation of a limb, and, alas, it often does. How to provide first aid for arterial bleeding without causing harm? Remember, in case of injury major artery There is not much time left, only 3-5 minutes. The algorithm of actions is as follows:

1. Do not wash or otherwise try to disinfect the wound, do not remove small fragments that have fallen there;
2. Apply pressure bandage as follows: apply directly to the wound sterile bandage or clean cloth, folded in several layers (it is advisable that the dressing material be sterile; if you don’t have one at hand, use any). Place another roller made of fabric on top. Then bandage everything tightly, after which the limb must be positioned above the level of the body. If everything is done correctly, the bleeding should stop;
3. If there is nothing at hand that could serve as a dressing material, you can try to stop the bleeding by maximum flexion a joint located above the wound;

First aid for bleeding and wounds using a tourniquet. This method is used if it is not possible to stop the bleeding in another way. The rules are as follows:

• A tourniquet (or any long piece of rubber, for example a rubber hose) is applied 5-7 cm above the wound, but not on bare skin, but on a cloth that should be wrapped around the limb, perhaps on a sleeve or pant leg;
• Having stretched the tourniquet, apply it in several turns without gaps between them, the first one is not too tight, each subsequent turn is tighter. A sign of a correctly applied tourniquet is stopping bleeding;
• The tourniquet should not be applied too tightly so as not to injure the nerves. If the tourniquet causes strong pain, the injured vessel must be pressed with a finger, the tourniquet must be removed, the victim should be allowed to rest from the tourniquet, then applied again;
• Be sure to record the time of application of the tourniquet! This is extremely important condition, which can save a person from possible disability. It is advisable to write the time for applying the tourniquet with a pen directly on the victim’s skin or clothing. Maximum time the length of time a tourniquet can be applied to is one and a half to two hours in summer and one hour in winter. During this time, the patient should be taken to the hospital; if this is not possible, and the time has expired, the tourniquet must be removed very carefully and slowly; if bleeding resumes, press the vessel with a finger above the wound.

First aid for venous bleeding occurs according to a similar algorithm, the only difference is that the vessel should be pressed below the wound.

First aid for nosebleeds

Typically, nosebleeds are not life-threatening, although they can look scary. However, blood loss can be significant. To prevent this, you must take the following actions:

1. In the nostril from which there's blood coming out, you need to insert a small swab of cotton wool, bandage, napkin or handkerchief. The tampon should not cause pain;
2. The person must be seated with his head slightly tilted down. A common mistake is made by people who, as first aid for nosebleeds, lay the person on his back or force him to throw his head back. This may cause blood to flow down the back wall pharynx;
3. Place on the nose area cold compress or any cold object;
4. Lightly squeeze the wings of the nose.

First aid for internal bleeding

Internal bleeding is difficult to recognize on your own. Its indirect sign after an injury is a deterioration in the person’s condition, paleness of the skin, cold sweat, darkening of the eyes. Blood may be released in vomit or feces, but not necessarily. If you notice such signs, the following should be done as first aid for internal bleeding:

• In case of a chest injury, place the person in a semi-sitting position; in case of an abdominal injury, place the person in a supine position;
• Provide a flow of fresh air;
• Apply cold to the stomach or chest;
• Prohibit the victim from eating, drinking, moving and talking;
• Take the person to the hospital immediately.

The last point is relevant not only for injuries to internal organs. When massive blood loss The main point of first aid for bleeding of any kind will be to transport the victim to the clinic to provide qualified medical care.

Such bleeding can be suspected only by changes in the general condition of the victim and by symptoms of fluid accumulation in a particular cavity.

Bleeding into the abdominal cavity is manifested by pallor, weak rapid pulse, thirst, drowsiness, darkening of the eyes, fainting. If there is bleeding in chest cavity these symptoms are combined with shortness of breath.

When bleeding into the cranial cavity, signs of compression of the brain come to the fore - headache, impaired consciousness, breathing disorders, paralysis, etc.

IN modern surgery Special attention given to internal bleeding. This is due to the fact that internal bleeding is much more difficult to diagnose compared to open bleeding. And that means the provided health care may be late. Internal bleeding is characterized by the outpouring of blood into the natural cavities of the body or artificially created spaces.

Depending on the amount of blood shed, there are three degrees of bleeding: moderate, moderate and severe.

The main reasons include: rib fractures with rupture of intercostal vessels and damage lung tissue, malignant neoplasms internal organs, closed damage liver, spleen, intestines, complications of diseases of organs such as the esophagus (with varicose veins), stomach and duodenum, liver, female genitals.

Main signs of internal bleeding:

• Sticky cold sweat
• Pallor
• Shallow breathing
• Pulse is frequent and weak

Signs and symptoms that are not so pronounced and may only become apparent after some time:

• Blue skin discoloration (hematoma formation in the area of ​​injury)
• Soft fabrics painful, swollen, or hard to the touch
• The victim feels nervous or restless
• Rapid weak pulse rapid breathing, nausea or vomiting, decreased level of consciousness
• Pale skin, cool or damp to the touch
• Feeling of unquenchable thirst
• Bleeding from natural orifices of the body (nose, mouth, etc.)

First aid for internal bleeding:

• Provide complete rest
• Place the victim in a semi-sitting position
• Apply ice or cold water
• Urgently transport the victim to a surgical hospital

Frequency of internal bleeding

Bleeding most often occurs when the gastrointestinal tract is affected. Therefore, it is worth getting acquainted with emergency methods gastrointestinal bleeding. In total, there are about 20 diseases, the most significant and common among which are: acute erosive gastritis and stomach cancer varicose veins esophageal veins, cirrhotic liver disease. In the case of stomach cancer, the danger is a disintegrating tumor. The only sign that allows the patient to suspect something is wrong is the darkening of the stool, which occurs due to the coagulated blood contained in it. If vomiting occurs, the vomited masses, again due to coagulated blood, have the color of coffee grounds.

Symptoms of internal bleeding depend on its location and the degree of blood loss. In some cases, it is necessary to distinguish bleeding from the esophagus or stomach from bleeding from a damaged lung. When lung pathology foamy, unchanged scarlet blood is released.

Diseases of the female reproductive system can also cause internal bleeding. Most common cause is a tubal abortion. When breaking fallopian tube blood accumulates in the abdominal cavity, creating a feeling of tension and some pressure in the pelvis, especially on the rectum. By the way, bleeding from anus is also quite common. Subsequently, irritation of the peritoneum with blood occurs, which leads to the development state of shock, loss of consciousness, fainting. The pulse in this case becomes frequent and thread-like. Upon examination, abdominal bloating, stool and gas retention are revealed. The patient becomes pale and covered in cold sweat.

Symptoms of hemothorax (blood in the chest)

How to identify and recognize internal bleeding in the chest? If blood accumulates in pleural cavity the development of so-called hemothorax occurs. The pleural cavity is a small space that separates the lungs from the chest. The reasons leading to the development of hemothorax include the following: falls from a height, injuries with damage to the ribs and intercostal vessels, stab wounds, lung cancer, lung abscesses(that is, the formation of abscesses in the lung tissue).

When blood accumulates in the pleural cavity, difficulty breathing occurs when inhaling and when coughing, sharp pains in the chest, a violation of the general condition - dizziness, weakness, fainting, pallor of the skin, increased heart rate and breathing, sweating. When percussing the patient’s chest, a shortening of the percussion sound over the affected half is revealed, a weakening or complete absence breathing. On an x-ray, it is possible to determine signs of mediastinal displacement towards the healthy lung.

Hemarthrosis (blood in the joint cavity)

A common joint lesion is the development of hemarthrosis, which means the accumulation of blood in the joint cavity. Arises similar condition as a result of injury, less often with hemophilia, scurvy. The anemic symptom is expressed insignificantly, in contrast to local symptoms. The clinic distinguishes three degrees. With hemarthrosis of the 1st degree, it is noted slight pain, the contours of the joint are slightly smoothed, the range of motion is not changed. In general, the volume of blood in the joint is up to 15 ml. Grade 2 is characterized by severe pain, which intensifies with exercise, and smoothness of the joint is noted. There is an increase in the circumference of the affected joint by 1.5 - 3 cm compared to a healthy one. In case of hemarthrosis knee joint Balloting of the patella is observed. The blood content in the cavity is up to 100 ml. At 3 degrees pain syndrome expressed acutely, the outlines of the joint are completely changed. The joint's circumference increases to 5 cm, and mobility is severely limited. Blood volume is more than 100 ml.

General symptoms

Thus, there are signs of bleeding that occur in any case, regardless of the source of the bleeding. Early signs include: pallor of the skin and visible mucous membranes, cold sweat, general weakness, dizziness, darkening of the eyes, if the lungs are affected - cough with streaks of blood, if organs are involved in the process digestive system- bloody vomiting or bloody diarrhea, symptoms of peritoneal irritation, which occurs when internal organs (spleen, liver, kidney) rupture. With moderate bleeding, a number of symptoms may be either mild or not appear at all

In other words, bleeding leads to the development of anemia. In addition to the above symptoms, anemia is manifested by increased heart rate and hypotension, that is, a decrease in blood pressure. The changed parameters directly depend on the degree of blood loss: with moderate - pulse no more than 75 beats per minute, systolic pressure decreases to 100 mmHg. Art.; with average - the pulse rises to 100 beats per minute, arterial pressure decreases to 90-80 mm Hg. Art.; in severe cases, the pulse rises to 120-140 beats per minute, systolic blood pressure drops below 80 mm Hg. Art.

Diagnostics

In case of combined trauma, laparocentesis is performed; it is a simple, fast, affordable and gentle method for diagnosing injuries to the abdominal organs and internal bleeding. An ultrasound of the abdominal organs is also sometimes performed.

An important point in confirming the diagnosis is laboratory research blood. The analysis reveals a decrease in the number of red blood cells, the amount of hemoglobin and a drop in hematocrit.

If such symptoms and diagnostic data are detected, it is necessary to immediately identify the cause of the underlying disease and begin treatment. It should be remembered that the earlier the cause of internal bleeding is identified, the more effective and rapid the recovery process will be.

Internal bleeding is one of the most dangerous species bleeding requiring immediate hospitalization.