Internal bleeding can occur following a road traffic accident(RTA). In the scene of a road traffic accidents and any other major type of physical trauma, the focus is usually on external blood loss through ugly wounds. When there’s none of such, the victim, and in some cases, the [perhaps naive] healthcare provider, heaves a sigh of relief, stemming from this false sense of safety. However, the fact is that one can be bleeding without any evidence apparent externally.
More often than not, such internal bleeds may prove fatal if not addressed, and ON TIME. You see, the body is full of cavities– spaces, into which one can bleed “comfortably” up to the point of exsanguination (severe loss of blood). There are the thighs which can hold up to 1 to 2 litres of blood; the chest which can hold upwards of 2 litres of blood; and the abdomen which can hold more than 4 litres! One may not really understand the implication of such bleeds, and the consequence of delayed intervention until one understands the following facts;
- That an acute loss of more than 15-20% of the total blood volume, without a concurrent ongoing replacement, could lead to IRREVERSIBLE shock, and death.
- That the total blood volume is approximately 5 litres; and that as little as one litre is already 20% of that volume!
This exposition puts into perspective how disastrous it could be not to recognize internal bleeding early enough. I could bore you with gory stories of deaths from both recognized and unrecognized internal bleeding, including the incident that spurred this writ. However, I’m not going to do that; I will instead talk about how to recognize ongoing internal bleeding following RTAs.
How to recognize an ongoing internal bleeding
The presence of the following in an accident victim, with no evidence of external blood loss, should raise suspicion for a possible ongoing internal bleeding.
At The Accident Site, Or In Transit;
- Excessive thirst.
- Disorientation/ Confusion [especially if there’s no head injury]
- Fast breathing.
- Palpitation [ undue awareness of one’s heart beat]
- Excessive sweating.
- Fainting, or feeling like fainting, on standing up abruptly.
- Icy cold and sweaty hands and feet.
In The Hospital;In the hospital, all of the above plus the following:
- Pallor [the pink/red part of the eyes looking pale as if drained of blood].
- A racing and difficult-to-feel pulse.
- Blood pressure less than 90/60 mmHg.
These are features of acute blood loss. If they are present, and there’s no external evidence of bleeding; then the blood is going somewhere else! And one needs to find out where, and do something pretty fast.
Identifying the site or source of the internal bleeding.
To identify the source of bleeding, let PAIN guide you. Pain is usually the first pointer to the possible site into which the victim is bleeding. Understandably, the victim may be feeling pain at multiple sites, having had a major physical traumatic event. However, the focus should be on either of this three;
- the Chest. – Especially if there’s a fracture of the ribs, and/or abnormal chest movement.
- the Abdomen. – Especially if there’s distention of the tummy.
- the Thighs. – Especially if there’s a fracture, or deformity, of the thigh bone.
WHAT TO DO Following any accident.,
Whether the above is present, or not; whether there are other obvious injuries, or not; the right thing to do is to GO TO A HOSPITAL for a thorough review!
Dr Chibuike Joseph Chukwudum is a doctor who Studied Medicine and Surgery at Nnamdi Azikiwe University Awka. He is the former Medical Officer at Oakland specialist hospital,obosi.He also previously worked at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State.