What Are The Types of Bleeding – Causes and First Aid

Bleeding, also known as hemorrhage, is the loss of blood from blood vessels due to injury or other underlying medical conditions. The bleeding can occur internally within the body or externally through the open wound. Bleeding can range from mild and easily controlled to severe and life-threatening.

Various factors, including trauma, injuries, surgical procedures, medical conditions, and certain medications can cause bleeding. Injuries such as cuts, punctures wounds, and lacerations, can lead to external bleeding while internal bleeding may result from conditions like ulcers, organ damage, or certain diseases.

Different Types of Bleeding

There are different types of bleeding depending on the source, rate, and amount of blood loss. In this section, we will discuss the main types of bleeding including arterial bleeding, venous bleeding, capillary bleeding, internal bleeding, and external bleeding. The causes, characteristics, and appropriate first aid for each type is also addressed. Having knowledge about the different bleeding types can help assess situations and provide proper care when bleeding occurs.

Arterial Bleeding

Arterial bleeding is the rapid and forceful release of blood from an artery, typically resulting from a severe injury. The bleeding often occurs from damage to arteries, which carry oxygenated blood at high pressure from the heart to the rest of the body. It is characterized by bright red blood that spurts with each heartbeat. Arterial bleeding requires immediate attention as it can quickly become life-threatening if not controlled. Applying direct pressure on the wound is the recommended first aid.

Characteristics of arterial bleeding:

• The blood is bright red because it is highly oxygenated, unlike darker venous blood.
• The bleeding flows in spurts or jets in time with the heartbeat, rather than a steady flow. This is because the arterial pressure shoots blood out with each pulse.
• There is a large volume of blood loss in a short amount of time. Uncontrolled arterial bleeding can quickly lead to hypovolemic shock.
• The bleeding site may not be obvious at first because the blood can obscure the wound. Look for bright red blood that seems to be pumping out.
• Blood loss can be severe and life threatening within just 2-3 minutes if not controlled.

Treatment of arterial bleeding:

Identifying and quickly controlling arterial bleeding is crucial. Seeking immediate medical assistance can be lifesaving when dealing with major arterial bleeding events. Recognizing the signs like pulsatile bright red blood allows rapid initiation of proper treatment.

• Apply direct pressure on the wound with a sterile dressing, and press firmly. This can slow blood loss. Do not lift or peek under the bandage.
• If needed, apply a tourniquet proximal to the wound to cut off blood flow. This is a last resort as it risks limb damage.
• Seek emergency medical help immediately. Definitive treatment is surgical repair of the damaged artery.
• Administer IV fluids and oxygen, and treat for hypovolemic shock per protocols.
• Monitor vital signs closely. Keep patient still – movement can dislodge clots.

Venous Bleeding

Venous bleeding is the slower, darker flow of blood from a vein, often resulting from a less severe injury compared to arterial bleeding. Venous bleeding comes from veins that carry deoxygenated blood back to the heart at lower pressure. It appears as a steady flow of dark red blood. Venous bleeding can still be serious but is usually not as rapid as arterial bleeding. Firm pressure should be applied and the wound elevated.

Characteristics of venous bleeding:

• The blood is dark red or maroon in color, unlike the bright red of arterial blood. This is because it has less oxygen.
• The bleeding flows at a steady pace rather than in spurts. This is due to the lower venous pressure compared to arterial pressure.
• Blood loss can be significant but usually not as rapid as arterial bleeding. However, a major vein can still lead to hypovolemic shock if uncontrolled.
• The wound may ooze blood or have a trickle flowing out. It does not spurt out.
• Venous bleeding may be fast initially but often slows as venous pressure reduces.

Treatment of venous bleeding:

The key is applying continuous direct pressure and lifting the bleeding limb. Venous bleeding usually responds well to these basic first aid measures. However, any major, uncontrolled bleeding should be evaluated by emergency medical services. Recognizing the dark steady flow of venous bleeding allows for prompt and proper treatment.

• Apply firm, direct pressure on the wound with a sterile dressing or towel. Elevate the limb if possible.
• Use a pressure bandage, or tourniquet only if direct pressure does not control bleeding.
• Watch for signs of shock, and manage airway, breathing, and circulation problems.
• Administer IV fluids if needed to maintain blood pressure. Monitor vital signs.
• Seek medical assistance for severe bleeding or if bleeding persists. Definitive treatment may involve surgical repair or cauterization.

Capillary Bleeding

Capillary bleeding, also known as petechiae, refers to bleeding from tiny blood vessels called capillaries. It appears as tiny reddish-purple spots on the skin or mucous membranes. Capillary bleeding can be caused by increased pressure in the capillaries that leads to rupture, low platelet counts (thrombocytopenia) that prevent proper blood clotting, use of blood thinning medications like aspirin or warfarin, and underlying bleeding disorders such as hemophilia. Any of these factors can lead to the small blood vessels bursting and leaking, resulting in the characteristic petechiae spots on the skin and membranes.

Characteristics of capillary bleeding:

• Pinpoint sized reddish-purple spots
• Often appear in clusters on the skin
• More common on the legs, ankles, feet and mucous membranes
• Does not spread or expand in size
• Color does not change when pressed

Treatment of capillary bleeding:

Though usually not dangerous itself, extensive capillary bleeding or petechiae spots that do not fade when pressed may indicate an underlying medical condition or bleeding disorder. Prompt identification through visual skin examination and checking for other symptoms like bruising and nosebleeds is important.

• Treating the underlying condition if present
• Stopping blood thinners if applicable
• Platelet transfusion if platelet counts are very low
• Controlling high blood pressure
• Applying pressure and ice to bleeding areas
• Raising legs to reduce pressure in capillaries

Internal Bleeding

Internal bleeding, also known as hemorrhage, is the loss of blood from damaged blood vessels inside the body. It is a very serious medical emergency that requires immediate medical attention.

Internal bleeding can be caused by traumatic injury, complications from surgery, or underlying medical conditions. It may present with low blood pressure, rapid heart rate, and breathing changes. Identification involves obtaining a patient history to assess trauma, surgery, or bleeding disorders.

Diagnostic tests like CT scans, ultrasounds, endoscopies, and blood tests can locate sources of bleeding. Early recognition of internal bleeding is crucial to preserve organ perfusion and enable prompt intervention.

Internal bleeding can quickly progress to hypovolemic shock as blood and fluid volumes decline, resulting in decreased oxygen delivery. This can lead to multi-organ failure and death without urgent treatment. Significant blood loss causes anemia, impairing oxygen carrying capacity. Bleeding in the brain can also cause hemorrhagic stroke and permanent brain damage. Swift recognition and management of internal bleeding is crucial to prevent these life-threatening complications.

Characteristics of internal bleeding:

• Blood loss into body cavities like the abdominal cavity (hemoperitoneum), chest cavity (hemothorax), retroperitoneal space, joints, muscles, etc.
• Coughing up or vomiting blood.
• Blood in urine or stool.
• Bruising that spreads or gets bigger.
• Dizziness, confusion, sweating, pale skin from blood loss.

Treatment of internal bleeding:

The key for internal bleeding is early recognition and prompt treatment. Bleeding that is not stopped quickly can lead to organ damage, shock and even death. Knowing the signs and getting medical care immediately gives the best chance for recovery.

• IV fluids and blood transfusions to restore blood volume.
• Surgery to find and stop the source of bleeding by cauterizing or suturing damaged vessels.
• Medications that promote clotting.
• Treatment of underlying conditions.
• Close monitoring of vital signs.

External Bleeding

External bleeding refers to blood loss occurring outside of the body through broken blood vessels. The bleeding type involves visible blood loss from damaged vessels outside the body. Prompt first aid and medical treatment is crucial to stop blood loss, replace fluids/blood, and prevent hypovolemic shock.

External bleeding can occur from lacerations, abrasions, puncture wounds, surgery, fractures, or arterial/venous ruptures leading to damaged blood vessels. Characteristics include visible bleeding from an open wound with bright red blood that may slowly ooze or rapidly spurt depending on the vessel injured. Blood will pool or spurt from the wound and severe bleeding may result in hypovolemic shock. Prompt identification of the wound and bleeding type is key for rapid treatment.

Identification:

• Visual cues like active bleeding from a wound
• Assessing wound size, depth, and blood flow amount
• Signs of hypovolemic shock like low blood pressure, rapid heart rate, dizziness

Treatment of external bleeding:

External bleeding results in blood volume loss, which can lead to life-threatening hypovolemic shock if severe. Open wounds that bleed externally also increase the risk for infection. Prompt treatment is essential to prevent complications from excessive blood loss through damaged vessels.

• Applying direct pressure to stop bleeding
• Elevating wound site above heart level
• Use of hemostatic agents or tourniquets for severe bleeding
• Suturing, stapling, or clipping damaged blood vessels
• Fluid resuscitation and blood transfusion
• Treating hypovolemic shock immediately

Common Causes of Bleedings

Bleeding can occur for various reasons, and it is essential to identify the underlying cause to determine the appropriate treatment. Some of the common causes of bleeding are:

Trauma

Accidents, injuries, or trauma to the body can result in bleeding. Below are some of the common types of damages caused by trauma:

• Cuts
• Scrapes
• Gunshots
• Wounds
• Punctures wounds caused by needles, nails, or knives
• Bruises or hematoma
• Injuries from crushing

Medical conditions

Bleeding can also occur due to medical conditions. Some conditions of bleeding caused by medical conditions are:

• Hemorrhagic disorders
• Leukemia
• Liver diseases
• Menstrual disorders
• Kidney disease
• Gastrointestinal conditions

Medicines

Specific treatments and medicines increase the chance of bleeding. The doctor will warn you about the bleeding and what to do in case bleeding occurs while prescribing the medicines or treatments. 

Below are some of the medications that can cause bleeding:

• Antibiotics if used for longer periods
• Blood Thinner
• Radiation therapy
• NSAIDs and other Aspirins

First Aid for Bleeding

The treatment of bleeding depends on the severity and the part of the body bleeding. Below are some of the general steps to manage bleeding:

• Stay Calm: You need to stay calm during the emergency to handle the bleeding effectively.
• Assess the Severity: First, determine the severity of the bleeding. Minor bleeding can be treated at home, while severe bleeding requires immediate medical attention.
• Apply direct Pressure: Apply direct pressure in the bleeding area using clean clothes or sterilized gauze pads. You need to maintain the pressure for 5 to 10 minutes, or until the bleeding stops. Avoid peeking to check if the bleeding has stopped, which can disrupt clot formation.
• Elevate the injured areas: If possible raise the injured area above the level of the heart. This can reduce blood flow to an extent and assist in slowing down the bleeding.
• Maintain Pressure: Seek medical assistance and continue maintaining pressure if the bleeding is severe or doesn’t stop.
• Use a tourniquet as a last resort: A tourniquet may be necessary in extreme cases where direct pressure cannot control bleeding. However, the tourniquet needs to be used as a last resort and applied by trained professionals only with caution, as these may have potential risks.
• Seek medical help:  It is crucial to seek medical help immediately, especially for severe bleeding that continues even after initial first aid efforts. Call 911 or visit the nearest healthcare facility. 
• Stay with the person: Stay with the person and provide comfort and assurance if the bleeding is severe and needs medical assistance. Monitor their breathing and other vital sign until medical assistance arrives.

Bleeding as a Sign of an Emergency

Bleeding can be a sign of a medical emergency depending on the severity and area of the bleeding, If you or someone is experiencing severe or uncontrolled bleeding seek immediate medical attention. Below are some of the situations when bleeding is considered an emergency:

1. Severe or uncontrolled bleeding: If bleeding cannot be controlled by applying pressure or is gushing out rapidly, it could be a sign of a severe injury or a medical condition requiring immediate attention.
2. Bleeding from major arteries: Bleeding from major arteries, such as those in the neck, groin, or limbs, can be life-threatening. It may result from a traumatic injury or a medical condition like aneurysm rupture. You should seek help from Emergency medical care immediately.
3. Head injury with bleeding: If bleeding from the head following a significant impact or trauma, it could be a sign of severe damage, such as a skull fracture or brain trauma. Immediate medical evaluation is necessary in such cases.
4. Bleeding during pregnancy: Pregnant women experiencing vaginal bleeding, mainly if it is heavy, accompanied by severe pain, or occurs in the later stages of pregnancy, should seek emergency medical attention. It could indicate complications such as placental abruption or ectopic pregnancy.
5. Gastrointestinal bleeding: Vomiting blood (hematemesis) or passing blood in the stool (hematochezia) could be signs of gastrointestinal bleeding, which may be caused by conditions such as ulcers, hemorrhoids, or gastrointestinal cancers. If the bleeding is significant or persistent, it requires urgent medical evaluation.

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