Internal Bleeding Due to Trauma

Internal bleeding is one of the most serious consequences of trauma. Usually, the bleeding results from obvious injuries that require rapid medical attention. Internal bleeding may also occur after a less severe trauma or be delayed by hours or days. Some internal bleeding due to trauma stops on its own. If the bleeding continues or is severe, surgery is required to correct it.

Causes of Internal Bleeding Due to Trauma

Internal bleeding may occur after any significant physical injury. There are two main types of trauma, and either may cause internal bleeding:

• Blunt trauma. This kind of trauma happens when a body part collides with something else, usually at high speed. Blood vessels inside the body are torn or crushed either by shear forces or a blunt object. Examples are car accidents, physical assaults, and falls.
• Penetrating trauma. This happens when a foreign object penetrates the body, tearing a hole in one or more blood vessels. Examples are gunshot wounds, stabbings, or falling onto a sharp object.

Almost any organ or blood vessel can be damaged by trauma and cause internal bleeding. The most serious sources of internal bleeding due to trauma are:

• Head trauma with internal bleeding (intracranial hemorrhage)
• Bleeding around the lungs (hemothorax)
• Bleeding around the heart (hemopericardium and cardiac tamponade)
• Tears in the large blood vessels near the center of the body (aorta, superior and inferior vena cava, and their major branches)
• Damage caused by trauma to the abdomen such as liver or spleen lacerations or perforation of other organs

Symptoms of Internal Bleeding Due to Trauma

In the large majority of cases of internal bleeding that results from trauma, the injury is obvious and serious. People naturally seek immediate medical help because of pain. Or witnesses call 911.

Sometimes, internal bleeding may occur after a less severe trauma. As the bleeding continues, symptoms appear and steadily get worse. Symptoms depend on the type of trauma and what body part was involved. For example:

• Abdominal pain and/or swelling can be caused by Internal bleeding from trauma in the liver or spleen. These symptoms get worse as the bleeding continues.
• Light- headedness, dizziness, or fainting can result from any source of internal bleeding once enough blood is lost.
• A large area of deeply purple skin (called ecchymosis) can result from bleeding into the skin and soft tissues.
• Swelling, tightness, and pain in the leg can result from internal bleeding in the thigh. Most often, this is caused by a fracture of the thighbone.
• Headache, seizures, and loss of consciousness could be the result of internal bleeding in the brain.

Any of these signs of internal bleeding after a trauma should be treated as a medical emergency. The injured person needs to be evaluated in a hospital emergency room.

Treatments for Internal Bleeding Due to Trauma

Internal bleeding damages the body both from the loss of blood and from the pressure the misplaced blood puts on other organs and tissues. Treatment usually takes place in a hospital's emergency department.

Intravenous fluids and blood transfusions may be given to prevent or correct an unsafe drop in blood pressure.

Imaging tests (usually an ultrasound, CT scan, or both) can identify whether internal bleeding is present. Doctors consider the amount of internal bleeding along with the injured person's blood pressure and severity of injuries to decide on the best initial treatment -- surgery or observation.

When internal bleeding is slower or delayed, observation may be appropriate at first. Sometimes, internal bleeding from trauma stops on its own.

Ongoing or severe internal bleeding due to trauma requires surgery to correct the problem. When internal bleeding is severe, emergency surgery may take place within minutes after arrival at the hospital.

The type of surgery used will depend on the location of the injury and bleeding:

• Exploratory laparotomy: A surgeon makes a large incision in the skin of the abdomen and carefully explores the abdomen. The surgeon will seal the ends of any leaking blood vessels with a heat probe or suture material.
• Thoracotomy: For bleeding around the heart or lungs, a surgeon makes an incision along the rib cage or the breastbone. Gaining access to the chest, the surgeon can identify and stop the bleeding and protect the heart and lungs from pressure caused by excess blood.
• Craniotomy: For bleeding due to traumatic brain injuries, a surgeon may create a hole in the skull. This can relieve pressure and reduce further injury to the brain.
• Fasciotomy: Internal bleeding into an area such as the thigh can create high pressure and prevent blood flow to the rest of the leg. A surgeon can cut deeply into the thigh to relieve pressure and gain access to stop the bleeding.

Some people have additional risk factors for internal bleeding due to trauma. These include:

• Use of "blood thinner" medications, such as aspirin, clopidogrel (Plavix), warfarin (Coumadin), rivaroxaban (Xarelto), apixaban (Eliquis), and dabigatran (Pradaxa)
• Severe liver disease or cirrhosis
• Inherited conditions that interfere with blood clotting ability, such as von Willebrand's disease or hemophilia

People with internal bleeding due to trauma who have these risk factors may receive additional treatments to help their blood clot properly.

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