From the Guidelines
Internal bleeding symptoms can manifest as abdominal pain, swelling, or rigidity, and may also include signs such as black, tarry stools, bruising, dizziness, rapid heart rate, low blood pressure, weakness, fatigue, pale skin, shortness of breath, confusion, and cold, clammy skin, as noted in various studies 1.
Symptoms of Internal Bleeding
The symptoms of internal bleeding can vary depending on the location and severity of the bleeding. Common symptoms include:
- Abdominal pain, swelling, or rigidity
- Black, tarry stools (melena) or bright red blood in vomit (hematemesis) indicating gastrointestinal bleeding
- Bruising or discoloration of the skin, particularly around the abdomen (Cullen's sign) or flanks (Grey Turner's sign)
- Dizziness, lightheadedness, or fainting due to blood loss
- Rapid heart rate (tachycardia) and low blood pressure (hypotension) as the body tries to compensate for blood loss
- Weakness, fatigue, and pale skin from decreased oxygen-carrying capacity
- Shortness of breath from reduced oxygen transport
- Confusion or altered mental status from decreased blood flow to the brain
- Cold, clammy skin as blood is diverted to vital organs
Importance of Immediate Attention
Internal bleeding is a medical emergency requiring immediate attention, as losing even 15-20% of the body's approximately 5-6 liters of blood can cause significant symptoms, as highlighted in a study from 1.
Diagnostic Approach
A complete medical history, physical examination, and laboratory tests such as a complete blood count (CBC), serum electrolytes, blood urea nitrogen (BUN), creatinine, and coagulation assessment are crucial in diagnosing and managing internal bleeding, as suggested by a recent guideline 1.
Treatment Options
Treatment depends on the cause and location of the bleeding but may include blood transfusions, medications to stop bleeding, or surgical intervention to repair the source of bleeding, as noted in a study on massive haemorrhage management 1.
From the Research
Symptoms of Internal Bleeding
- Internal bleeding can manifest in various ways, including:
- Abdominal pain or tenderness
- Nausea and vomiting
- Dizziness or fainting
- Weakness or fatigue
- Shortness of breath
- Rapid heart rate
- Pale or cool skin
- Decreased urine output
- The symptoms of internal bleeding can vary depending on the location and severity of the bleeding, as well as the individual's overall health.
Treatment and Management
- Tranexamic acid (TXA) has been shown to be effective in reducing blood loss and improving outcomes in various surgical specialties, including cardiac surgery 2, abdominal and pelvic surgery 3, 4, and gastrointestinal bleeding 5.
- TXA can reduce the need for blood transfusions and decrease the risk of thromboembolic events, although the evidence is not consistent across all studies 2, 5.
- The use of TXA in patients with internal bleeding may help to reduce the risk of further bleeding and improve outcomes, although more research is needed to fully understand its effects in this context.
Complications and Risks
- Internal bleeding can lead to serious complications, including:
- Organ failure
- Shock
- Respiratory failure
- Cardiac arrest
- Death
- The use of TXA in patients with internal bleeding may be associated with an increased risk of thromboembolic events, although the evidence is not consistent across all studies 2, 5.
- Patients with internal bleeding should be closely monitored and managed by a healthcare team to minimize the risk of complications and improve outcomes.