The most common form of internal bleeding is a bruise. This is where blood vessels leak into the surrounding skin. Other types of internal bleeding can be non-visible and far more dangerous. It’s useful to be able to spot the signs and symptoms of internal bleeding so that the casualty can receive life saving treatment.
Internal bleeding can be split into two categories: visible & non-visible. The clue is obviously in the titles where one type is easily noticed (visible) and the other type (non-visible) can be concealed, and will require detective work in order to establish if internal bleeding is present. 

Causes

Accidents like a car crash or fall from height can cause the inner body parts / organs to collide with something else (typically at high speed). This is known as a blunt trauma, where blood vessels can be severely torn or crushed. The subsequent damage to the blood vessels can then cause internal bleeding.

The other cause of internal bleeding is from a penetrating foreign object, which can enter the body and damage the inner blood vessels. This could be a stab wound, gunshot wound, or happen when the body falls onto another object.

Visible - Internal Bleeding

Visible internal bleeding can often be seen as the blood escapes from the orifice nearest to the site of the injury. Look out for the following areas when performing a secondary survey on the casualty:
  • Head injury - Blood leaving the ears and nose
  • Lung injury - Coughed up, bright red frothy blood
  • Bowel injury - Bleeding from anus
  • Stomach - Dark red blood within vomit
  • Urinary tract - Blood in urine 

Non-Visible


Non-visible bleeding is far harder to detect and the first aider will need to rely on the signs & history at the scene. This can be achieved through asking questions and relying on gut instinct to establish what has happened. This could be for example: that the casualty has been involved in a serious car accident, or fall from height.  Look out for the following signs and symptoms:

  • Pain at the site of the injury
  • Light-headedness, dizziness 
  • Signs of concussion (head injury)
  • Symptoms of physiological shock
  • Swollen, tight abdomen
  • Changes to breathing pattern
In these cases the internal bleeding can stay contained within the body, eg within the skull or inner abdomen. The casualty may not display symptoms at first, or they can be delayed by hours or even days.

Treatment

 
Treatment of internal bleeding is generally outside of the scope of first aid and will require emergency medical treatment within hospitals in order for the casualty to recover. However first aider’s can prevent the condition worsening by following the below 4 step treatment protocol
  1. Dial 999/112 (explain the seriousness of the situation)
  2. Lay them down, keep warm & elevate the legs where possible
  3. If the casualty becomes unconscious place them in the recovery position Lie them on their injured side (when known)
  4. Check breathing and prepare for CPR if breathing was to stop
Lying someone on their injured side allows the good / working side to function correctly. This can assist with breathing and blood flow.