Title: Internal bleeding
Course: Non-Communicable Diseases, Emergency Care and Mental Health Part 1 - Ethiopia (Full)

Internal bleeding

This type of bleeding occurs when there is a rupture of arteries or veins inside the body, for example in the abdomen. It may be caused by a kick or violent blow, a fall or another type of accident. You should remember that even though the affected person does not show any sign of bleeding externally, there may be significant damage to the internal organs, usually to the liver, spleen or thigh bone (see Section 7.3.1 below), resulting in a large amount of hidden internal bleeding. The signs that should make you suspect internal bleeding are given in Box 7.2.

Box 7.2 Signs indicating internal bleeding

Be alert for the following signs:

- Pain at the site of impact, reported by the patient
- Tenderness (feeling of pain by the affected person upon palpation)
- Rigid abdominal muscles (guarding an internal injury)
- Bleeding from other sites, e.g. from the nose or ears
- Signs of shock.

Measure the injured person's blood pressure and pulse rate. If you suspect they have internal bleeding, lie the person down on their back. Raise their legs in an attempt to improve their blood pressure by allowing some blood from the legs to drain back towards the heart. Get someone to hold the person's legs up for you, or use pillows to support them (Figure 7.2). Then secure an intravenous (IV) cannula in a vein in the person's hand or arm and begin fluid infusion with a litre of Normal Saline or Ringer's Lactate solution. Then transfer them urgently to the nearest health facility.

Do not allow an injured person to eat or drink anything before their emergency transfer to a health centre or hospital!

Figure 7.2 Raise the person's legs to increase their blood pressure if you suspect internal bleeding.

Do not allow the person to eat or drink anything before or during the journey to a health centre or hospital. Their condition may require surgical treatment to stop the internal bleeding, and food or fluids inside the stomach can be vomited into the lungs during surgery.