How to Tell if a Bleed Is Life-Threatening
Life-threatening bleeding can occur suddenly and without warning—usually from a traumatic injury—and immediate action is needed to prevent the patient from bleeding to death. Knowing how to tell if bleeding is life-threatening and how to respond could save someone’s life.
Signs of Life-Threatening External Bleeding
External bleeding may be life-threatening if:
- Blood is spurting out of the wound.
- Blood is exiting the wound in a pulsating rhythm.
- Blood is pooling on the ground.
- Blood is soaking through the patient's clothing.
- Blood is soaking through a bandage.
- There is a slow, steady flow of bright red or dark red blood.
- The patient is missing part or all of a limb (arm or leg, including fingers).
- The patient is confused, disoriented, cool, pale, sweaty, or unconscious.
External bleeding is not likely to be life-threatening if:
- The wound is dripping rather than flowing.
- There is a slow trickle of blood that quickly stops with direct pressure.
If a wound is not exposed but you see blood soaking through the patient's clothes (or the patient is confused, disoriented, cool, pale, sweaty, or unconscious), call emergency services, put on sterile gloves (if available), locate the source of the bleeding, cut away any clothing around the wound, and treat the wound.
How to Treat Life-Threatening External Bleeding
- Call 911 (in the United States), and grab a bleeding control kit if available.
- After locating the wound or wounds, apply direct pressure with hemostatic gauze (use regular sterile gauze instead of hemostatic gauze for an abdomen, chest, or open skull wound). If no gauze is available, you can use a folded bandage or a clean piece of clothing.
- If the bleeding doesn't stop after a minute or so and the wound is located on an arm or leg, apply a tourniquet correctly, tighten it until the bleeding stops, secure it, and write down the time it was applied.
- If the wound is located on the torso, neck, head, or junctional area (armpit or groin), pack the wound and apply direct pressure until medical responders arrive.
- If the wound is located on the chest, apply a chest seal if available (these are included with many premium bleeding kits). If no chest seal is available, apply direct pressure with gauze or clothing.
Special Cases with External Bleeding
So far, we've covered signs that a visible bleeding wound could be life-threatening and explained what to do. However, there are certain kinds of external injuries that require a special response.
If a limb is entrapped or otherwise inaccessible and you can't assess the severity of the bleeding (you might see blood soaking through the person's clothing or might not be able to see the wound at all), you should assume severe bleeding, call 911, and apply a tourniquet 2-4 inches above the wound, above a joint rather than over a joint. If the wound isn't visible, apply the tourniquet near the part of the limb that’s closest to the heart.
If there are multiple patients—such as in a shooting or natural disaster—and it's not practical to maintain pressure on their wounds, call 911, apply a tourniquet above extremity wounds that are more than dripping with blood, and pack any wounds on the groin, abdomen, and head.
In the case of an amputation, apply a tourniquet if possible. Otherwise, apply direct pressure if the limb is severed too high to apply a tourniquet. Place the severed part in a clean Ziploc bag or plastic bag and close it with a bit of air for cushioning. Then, put the bag in a bucket of cold water with ice cubes and give it to EMS personnel to transport to the hospital with the patient.
Injuries to The Neck, Chest, Abdomen, Pelvis, or Groin
Injuries to the neck, chest, abdomen, pelvis, or groin can cause severe internal bleeding if they perforate a blood vessel or organ. Even if it doesn't look serious on the surface, seek medical care urgently for an injury affecting any of these body parts.
Signs of Life-Threatening Internal Bleeding
Internal bleeding can be visible or invisible. Either way, it can be life-threatening. Visible signs of internal bleeding include:
- Coughing up blood
- Blood-stained vomit that might look like coffee grounds
- Urine with a red or rusty tinge
- Dark feces that look like tar
- Heavier-than-normal bleeding from the vagina during a period or after childbirth (the blood soaks through more than one pad every two hours or there are blood clots larger than the size of a dime)
- Blood flowing unexpectedly from any of the body's orifices: nose, eyes, ears, mouth, anus, urethral meatus (pee hole), or vagina
- An area that is bruised and swelling, which means blood is pooling under the skin
Signs of invisible internal bleeding include:
- Rapid breathing or gasping breaths
- Increasing feelings of thirst
- Pale, cold, and sweaty skin
- Confusion, disorientation, unease, and anxiety
Because it's difficult to know how severe internal bleeding might be, it's best to treat it as life-threatening if you have any suspicion whatsoever.
- Call 911.
- If it’s safe to approach, take the injured person to a safe place on a warm surface (i.e. cover a sidewalk or parking lot with a blanket before laying the patient down).
- Treat any other injuries.
- Loosen any tight clothing, especially at the neck and waist.
- Cover the patient with a blanket to maintain body heat.
- Elevate the patient's legs to promote blood flow to the heart.
- Do not allow the patient to eat, drink, or smoke anything.
- Keep bystanders clear and reassure the patient.
Special Cases with Internal Bleeding
There are a couple of cases of internal bleeding that require special monitoring or treatment.
Nosebleeds aren't usually life-threatening. However, if the blood coming out of the nose is coming from a perforated blood vessel or an internal injury, it could be life-threatening.
- If blood is flowing (rather than dripping or trickling) out of the nose, call for emergency help IMMEDIATELY. In the United States, call 911.
- Have the patient sit upright with their head tilted forward.
- Pinch the nose to stop or slow the bleeding and ask the patient to breathe through their mouth.
- If the nosebleed was a trickle or drip but hasn't stopped after 20 minutes of continuous pressure, continue applying pressure and call 911.
When something heavy falls on or otherwise crushes part of the body, it can cause internal bleeding. Crush injuries to the head, neck, chest, abdomen, and thigh are especially dangerous. If you suffer a crush injury, witness a crush injury, or find someone with a crush injury—such as in the cleanup from a natural disaster, call 911, apply a tourniquet above any obvious crush injuries to an extremity (to control internal bleeding), and write down the time any tourniquets were applied.
Non-Life-Threatening Bleeding From an Orifice
It's better to err on the side of caution when it comes to internal bleeding. However, it can still help to know when blood coming out of an orifice is not likely to be dangerous.
- Blowing your nose too hard. After blowing your nose repeatedly and hard, you may see a tinge of blood coming out with the mucus. This is usually a sign that a small blood vessel has burst. If this occurs but no blood comes out unless you blow, refrain from blowing or picking at your nose for 24 hours, then blow more softly. If no blood comes out, no medical attention is required.
- Bleeding hemorrhoids. Straining on the toilet can put pressure on a hemorrhoid and cause it to bleed. If you've just passed a hard stool and there's a little blood on the toilet paper when you wipe (but blood is not flowing), it's not an emergency and can usually be treated at home with a hemorrhoid ointment or cream and taking measures to soften subsequent stools. Seek medical attention if the bleeding continues or if you suffer from chronic constipation.
- A young breastfeeding baby spits up milk with blood. Blood that comes out with a young baby’s spit-up is usually from the mother and not from the baby. It may have been ingested from the mother’s cracked nipples, clogged or infected milk ducts, or have been swallowed during birth. If the baby spits up or vomits blood and also has a fever, swollen belly, green vomit, or lethargy, seek medical attention urgently. Otherwise, resolve any breastfeeding issues and follow up with the baby’s pediatrician if symptoms persist.
Know the Signs of Life-Threatening Bleeding and Act Fast
When there is a constant flow of blood from an external or internal injury (i.e. it’s not something minor like we described above), bleeding can turn fatal more quickly than most people think.
To identify dangerous bleeding quickly, look for:
- Blood that's flowing from a wound or orifice
- Wounds to the groin, pelvis, abdomen, chest, or neck
- A bruise that's expanding or swelling up
- A crush, entrapment, or amputation injury
- A victim who is disoriented, breathing rapidly (or in gasps), cold, pale, and/or sweating
- A victim who is unconscious
In all of these cases, call 911, approach the patient if safe, treat any visible wounds using any bleeding kits that are available (or strips of clean clothing or cloth if no bleeding kit is available), and provide reassurance. If you can stop the bleeding or slow it considerably until EMS arrives, you may just save the patient's life.