Management of Internal Bleeding Caused by Trauma

Introduction:

Bleeding inside the body into the body cavities, abdomen, chest, digestive tract, around large broken bones, and other tissues and organs are termed internal bleeding. Severe internal bleeding, if not treated or uncontrolled, can be life-threatening. Bleeding inside the body usually results from trauma. Bleeding disorders, organ damage, and inflammation, such as gastritis, can also lead to internal bleeding. However, these are not obvious (we cannot see the bleeding easily), so diagnosing them is difficult. This article highlights the key information on managing internal bleeding caused by trauma. Untreated severe internal bleeding may lead to unconsciousness, organ failure, shock, coma, and even death. Therefore, it is essential to initiate medical care to prevent internal bleeding complications promptly.

What Types of Trauma Cause Internal Bleeding?

Internal bleeding is one of trauma patients' most common and serious consequences. In most trauma cases, bleeding occurs from obvious wounds and cuts, requiring immediate medical care. Unfortunately, internal bleeding is often missed initially, and the treatment gets delayed by hours or even days leading to many complications. Some less severe internal bleeding resolves on its own. However, surgical management is essential to treat if the bleeding is severe or continuous. The significant trauma causing internal bleeding is categorized as the following:

1. Blunt Trauma: This occurs when the body part collides with an object at high speed, such as in road traffic accidents, falls, and physical assaults. The blunt object or shear forces tear or crush the blood vessels in the body leading to internal bleeding.

2. Penetrating Trauma: Penetrating trauma occurs when an object penetrates the patient's body, tearing or cutting the blood vessels. For example, gunshot wounds, falling on or collision with a sharp object, or stabbings can cause internal bleeding along with open wounds or cuts.

What Are the Most Common Sources of Internal Bleeding in Trauma?

Trauma can damage any blood vessel or organ in the body. The most serious and common sources of internal bleeding include:

1. Intracranial Hemorrhage - Internal bleeding in the head due to head injury.

2. Hemothorax - Bleeding in and around the lungs.

3. Hemopericardium - Bleeding around the heart that can exert life-threatening pressure on the heart (cardiac tamponade).

4. Large Blood Vessel Damage - Trauma to the neck and chest can cause damage and tear of the large blood vessels, such as the aorta, vena cava, or their large branches, resulting in internal bleeding.

5. Trauma leading to organ damage (such as the spleen or liver) can lead to internal abdominal bleeding.

What Are the Symptoms of Internal Bleeding in Trauma Patients?

Usually, the patients or witnesses call for emergency medical services in case of major trauma due to obvious injuries and pain. Internal bleeding in minor or less severe trauma is generally missed unless symptoms occur due to steady bleeding or worsening of the patient's condition. The symptoms vary based on the part of the body involved and the trauma's nature (type and severity). The following symptoms of internal bleeding due to trauma are considered medical emergencies and should be managed immediately in the emergency department:

• Pain in the abdomen, with or without swelling (internal bleeding in the organs such as the spleen or liver).

• Light-headedness.

• Dizziness.

• Unconsciousness.

• Ecchymosis (deep purple discoloration of a large skin area) results from bleeding into the skin and underlying tissues.

• Headache and seizures (seen in brain injury).

• Swelling and pain in the affected area, such as hands or legs (due to fracture of bones).

How Is Internal Bleeding Managed?

There is blood loss when internal bleeding occurs in the body due to trauma. The blood pools in another body area and exerts pressure on the region's organs and tissues. Treatment for internal bleeding is usually done in the hospital's emergency department. The general management includes the following:

1. Imaging tests such as computerized tomography scans or ultrasounds are performed to identify the presence of internal bleeding and its source.

2. With blood loss, the blood pressure drops to unsafe levels, which can be fatal. Thus, intravenous fluids and blood transfusion administration are essential for patients with significant blood loss.

3. The amount of blood loss due to the bleeding determines the best treatment option. When the bleeding is less, slow, or delayed, the patient is usually kept under observation initially to check for spontaneous resolution of the problem.

4. Continuous internal bleeding due to major trauma requires emergency surgery (within minutes of arrival at the emergency department) to stop the bleeding and correct the underlying problem.

5. Some patients may have additional risk factors that prevent their blood from clotting properly, such as using blood thinning medications, severe liver disease, or inherited conditions that affect the normal clotting mechanisms. Such patients are treated with additional care and treatments to stop bleeding.

What Are the Various Surgical Interventions to Treat Internal Bleeding?

The surgical interventions performed depend on the location of the trauma and bleeding. These include:

1. Exploratory Laparotomy: A large incision (surgical cut) is made on the abdomen to explore the source of the bleeding. Once the blood vessels that have been injured are identified, their leaking ends are sealed with a suture or heat probe.

2. Thoracotomy: This is performed when there is bleeding around the lungs or heart. This is a life-threatening condition as excess pressure is exerted by internal bleeding on the heart and lungs, which affects their function. A surgical incision is made along the rib cage to gain access to the chest. The chest is explored to identify the source of bleeding around the heart and the lungs. Measures are taken to seal the leaking blood vessels and to stop further bleeding.

3. Craniotomy: Craniotomy is performed for internal bleeding resulting from head and brain injuries. A surgical hole is made in the skull to relieve pressure in and around the brain and prevent further damage.

4. Fasciotomy: When trauma results in internal bleeding in a body part such as the thigh, it creates a high pressure in the region that prevents blood flow to other leg parts. Fasciotomy is a procedure in which a deep surgical cut is made in the thigh to relieve pressure and prevent further bleeding into the area.

Conclusion:

Internal bleeding may not cause symptoms in the initial stages, or the patient's condition might be critical (confused, drowsy, or unconscious) due to trauma. It is essential to seek immediate medical treatment if the patients experience symptoms such as dizziness, excessive sweating, bloody stool, or vomiting blood. Excessive internal bleeding lowers blood pressure leading to life-threatening medical emergencies. In case of excessive internal bleeding, the patient must be made to lie down, and their legs must be kept elevated until emergency help arrives. Emergency medical care is essential to save a person with severe internal bleeding.