First Aid & Emergencies

Internal Bleeding Due to Trauma

Treatments for Internal Bleeding Due to Trauma continued...

Intravenous fluids and blood transfusions may be given to prevent or correct an unsafe drop in blood pressure.

Imaging tests (usually an ultrasound, CT scan, or both) can identify whether internal bleeding is present. Doctors consider the amount of internal bleeding along with the injured person's blood pressure and severity of injuries to decide on the best initial treatment -- surgery or observation.

When internal bleeding is slower or delayed, observation may be appropriate at first. Often, internal bleeding from trauma stops on its own.

Ongoing or severe internal bleeding due to trauma requires surgery to correct the problem. When internal bleeding is severe, emergency surgery may take place within minutes after arrival at the hospital.

The type of surgery used will depend on the location of the injury and bleeding:

• Exploratory laparotomy: A surgeon makes a large incision in the skin of the abdomen and carefully explores the abdomen. The surgeon will seal the ends of any leaking blood vessels with a heat probe or suture material.
  
• Thoracotomy: For bleeding around the heart or lungs, a surgeon makes an incision along the rib cage or the breastbone. Gaining access to the chest, the surgeon can identify and stop the bleeding and protect the heart and lungs from pressure caused by excess blood.
  
• Craniotomy: For bleeding due to traumatic brain injuries, a surgeon may create a hole in the skull. This can relieve pressure and reducing further injury to the brain.
  
• Fasciotomy: Internal bleeding into an area such as the thigh can create high pressure and prevent blood flow to the rest of the leg. A surgeon can cut deeply into the thigh to relieve pressure and gain access to stop the bleeding.

Some people have additional risk factors for internal bleeding due to trauma. These include:

• Use of "blood thinner" medications, such as clopidogrel (Plavix), warfarin (Coumadin), and dabigatran (Pradaxa).
• Severe liver disease or cirrhosis.
• Inherited conditions that interfere with blood clotting ability, such as von Willebrand's disease or hemophilia.

People with internal bleeding due to trauma who have these risk factors may receive additional treatments to help their blood clot properly.