Bleeding

Bleeding is the loss of blood from the circulatory system. It can range from small cuts and abrasions to deep wounds and amputations. Injuries can also cause internal bleeding, which ranges from minor (such as superficial bruising) to massive.

First aid for severe external or internal bleeding is critical: it helps limit blood loss until emergency medical help arrives. For external bleeding, the key actions are to apply direct pressure to the wound, maintain that pressure with pads and bandages, and raise the injured limb above the level of the heart if possible.

Always call your local emergency number in an emergency.

Minor bleeding#

Small cuts and abrasions that are not bleeding heavily can usually be managed at home.

• Clean the injured area with sterile gauze soaked in normal saline or clean water.
• Do not use cotton wool or any material that frays or leaves fluff in the wound.
• Apply a suitable dressing, such as an adhesive bandage or a non-adhesive dressing held in place with hypoallergenic tape.
• Change the dressing regularly.

If you cannot remove the dirt yourself, see your doctor – a dirty wound carries a high risk of infection. If you have not had a tetanus booster in the last five years, see your doctor.

Nosebleeds#

Bleeding from the nose is usually not severe.

• Sit the person upright and ask them to tilt their head forward.
• Using the thumb and a finger, squeeze the soft part of the nostrils shut.
• Hold for at least 10 minutes, then release gently and check for bleeding.
• If the bleeding has stopped, advise the person not to blow or pick their nose for the rest of the day.

Seek medical help if the bleeding continues beyond 20 minutes, or if the nosebleed happens again.

Severe external bleeding#

Even a small injury can cause severe external bleeding, depending on where it is on the body. Heavy blood loss can lead to shock – a life-threatening emergency in which there is no longer enough blood circulating around the body.

To manage severe external bleeding:

• Check for danger before approaching the injured person.
• Put on gloves (nitrile, if available).
• If possible, send someone else to call your local emergency number for an ambulance.
• Lie the person down.
• If a limb is injured, raise it above the level of the heart if possible.
• Get the person to apply firm, direct pressure to the wound with their hand or hands. If they cannot, apply the pressure yourself. You may need to pull the edges of the wound together before applying a dressing or pad.
• Cover the wound with a dressing or pad and secure it firmly with a bandage.
• If an object is embedded in the wound, do not remove it. Apply pressure around the object instead.
• Do not apply a tourniquet.
• If blood soaks through the first dressing, do not remove it. Add fresh padding over the top and secure it with a bandage.

Internal bleeding#

The most common visible internal bleed is a bruise, where blood from damaged vessels leaks into the surrounding skin. Some internal injuries cause visible bleeding from a body opening, for example:

• urinary tract injury – blood in the urine
• bowel injury – bleeding from the anus
• head injury – bleeding from the ears or nose
• lung injury – coughing up frothy, blood-stained sputum

An injured person may be bleeding internally even when you cannot see any blood. Internal bleeding can stay contained within the body, for example within the skull or the abdominal cavity. Listen carefully to what the person tells you about the injury, such as where they felt the impact, and ask questions to gather useful information. They may show signs of shock, and a head injury may also cause signs of concussion.

The signs and symptoms of concealed internal bleeding depend on where it is, but may include:

• pain at the injured site
• a swollen, tight abdomen
• nausea and vomiting
• pale, clammy, sweaty skin
• breathlessness
• extreme thirst
• headache or dizziness
• confusion or an altered state of consciousness, leading to unconsciousness

Signs that may point to concussion (from a blow to the head) include vomiting, headache, dizziness, loss of memory (particularly of the event itself), confusion, and wounds on the head, face or scalp.

First aid cannot treat internal bleeding, so prompt medical help is vital. While waiting for the ambulance:

• Check for danger before approaching the person.
• If possible, send someone else to call your local emergency number for an ambulance.
• Check whether the person is conscious.
• Lie the person down and cover them with a blanket to keep them warm.
• If possible, raise their legs above the level of the heart.
• Do not give them anything to eat or drink.
• Offer reassurance and manage any other injuries if you can.
• If the person becomes unconscious, place them on their side, check their breathing frequently, and begin CPR (cardiopulmonary resuscitation) if necessary.

Preventing the spread of disease#

Some diseases can be spread through open wounds, so protect yourself and the injured person:

• If possible, wash your hands with soap and water before and, especially, after giving first aid.
• Dry your hands thoroughly before putting on gloves.
• Always wear gloves if available (first aid kits usually contain them). If you have none, improvise.
• Do not cough or sneeze over the wound.

Key points#

• Bleeding ranges from minor cuts and abrasions to deep wounds, amputations and internal bleeding.
• A dirty wound carries a high risk of infection; see your doctor if you cannot clean it or are not up to date with tetanus protection.
• For severe external bleeding, apply firm direct pressure, maintain it with pads and bandages, and raise the injured area above the heart if possible.
• A person may be bleeding internally even when no blood is visible, and may show signs of shock – this is a medical emergency.
• For internal bleeding, lay the person down, raise their legs, keep them warm, give nothing to eat or drink, and call your local emergency number.

Where to get help and trusted information#

For evidence-based global health guidance, see Source: World Health Organization (WHO).