Signs and symptoms - First Aid


First aid

First aid


What are they What to do Nasal haemorrhage (epistaxis) Cough haemorrhage (hemoptysis) Vomiting haemorrhage (hematemesis) Vaginal haemorrhage (menometrorrhagia) Intestinal haemorrhage (enterorrhage)
  • What are they
  • What to do
  • Nasal bleeding (epistaxis)
  • Cough bleeding (hemoptysis)
  • Vomiting bleeding (hematemesis)
  • Vaginal bleeding (menometrorrhagia)
  • Intestinal bleeding (enterorrhage)

Signs and symptoms

External bleeding is evident from the leakage of blood from a skin lesion. Internal bleeding, even serious, can remain hidden even for hours, dangerously delaying therapeutic interventions. If internal bleeding occurs in a cavity communicating with the outside (e.g. the digestive tract, bladder, uterus, bronchi) the lost blood can become visible if it is expelled, for example from the stomach with vomiting (hematemesis), from the intestine with feces (hematochezia, melena), from the bladder with urine (hematuria), from the bronchi with cough (hemophtoe, hemoptysis), or from the vagina (metrorrhagia). On the contrary, in bleeding in closed cavities, such as the abdomen (hemoperitoneum), the pleura (hemothorax), the pericardium (hemopericardium), the cranial cavity (cerebral hemorrhage), the blood remains hidden inside the body and its escape it can only be suspected because it occupies spaces normally destined for other organs, disturbing their functioning. For example, hemothorax compresses the lung, causing breathing difficulties; Cerebral hemorrhages compress the brain resulting in neurological disorders. Moreover, if the blood collection compartment is very large and contains organs that can at least partially give up the space they occupy (as in the abdominal cavity, in which the intestine can be compressed and moved without any damage), the bleeding can remain asymptomatic (or almost), at least until it reaches a certain entity. In fact, regardless of where they occur, large bleeding always causes general symptoms, due to the progressive decrease in the volume of circulating blood (hypovolemia). Blood losses of less than 15% of the total blood mass cause few disturbances; however, if the loss reaches 15% -30% an increase in heart rate and respiratory rate is observed, the skin becomes pale, especially at the extremities, and diuresis contracts (oliguria). These manifestations can be interpreted as attempts by the body to "make the best use of the little blood left": the heart and breath accelerate, to guarantee acceptable nourishment and oxygenation to the tissues; the cutaneous and muscular vessels narrow (vasoconstriction) to divert their blood to more critical organs for survival; the kidneys retain as much water as possible, in order to increase the volume of circulating blood. An even higher loss, between 30% and 40%, leads to marked tachycardia and tachypnea, cold sweating, drop in blood pressure, weakening of the wrists, anxiety and mental confusion, due to the poor blood supply of the brain. If more than 40% of the circulating blood is lost, hypovolemia becomes critical for survival (hypovolemic hemorrhagic shock): the wrists disappear, the patient becomes lethargic or comatose, the kidneys stop producing urine and death can occur.

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