Which assessment would the nurse perform to determine the presence of external bleeding

Why you should read this article:

• • To improve your knowledge of the pathophysiology and classification of haemorrhage and haemorrhagic shock

• • To support your practice in assessing and managing patients who present with haemorrhage or haemorrhagic shock

• • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers)

• • To contribute towards your professional development and local registration renewal requirements (non-UK readers)

Haemorrhage is defined as the acute loss of blood from the circulating volume, while haemorrhagic shock is characterised by suboptimal perfusion caused by bleeding. Their prompt recognition and management is vital to ensure optimal outcomes. This article discusses the assessment and management of patients experiencing haemorrhage and developing haemorrhagic shock. It also outlines how these conditions are classified, and explains their pathophysiology. The article emphasises the importance of a thorough ABCDE (airway, breathing, circulation, disability, exposure) assessment and prompt identification of the source of bleeding, along with the initial management of a patient who is bleeding.

Nursing Standard. doi: 10.7748/ns.2020.e11600

Peer review

This article has been subject to external double-blind peer review and checked for plagiarism using automated software

@gabs_funk

Correspondence

Conflict of interest

None declared

Wilcox GC (2020) Management of haemorrhage and haemorrhagic shock. Nursing Standard. doi: 10.7748/ns.2020.e11600

Published online: 29 October 2020

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Signs and symptoms of disseminated intravascular coagulation (DIC) depend on its cause and whether the condition is acute or chronic.

Acute DIC develops quickly (over hours or days) and is very serious. Chronic DIC develops more slowly (over weeks or months). It lasts longer and usually isn't recognized as quickly as acute DIC.

With acute DIC, blood clotting in the blood vessels usually occurs first, followed by bleeding. However, bleeding may be the first obvious sign. Serious bleeding can occur very quickly after developing acute DIC. Thus, emergency treatment in a hospital is needed.

Blood clotting also occurs with chronic DIC, but it usually doesn't lead to bleeding. Sometimes chronic DIC has no signs or symptoms.

Signs and Symptoms of Excessive Blood Clotting

In DIC, blood clots form throughout the body's small blood vessels. These blood clots can reduce or block blood flow through the blood vessels. This can cause the following signs and symptoms:

• Chest pain and shortness of breath if blood clots form in the blood vessels in your lungs and heart.
• Pain, redness, warmth, and swelling in the lower leg if blood clots form in the deep veins of your leg.
• Headaches, speech changes, paralysis (an inability to move), dizziness, and trouble speaking and understanding if blood clots form in the blood vessels in your brain. These signs and symptoms may indicate a stroke.
• Heart attack and lung and kidney problems if blood clots lodge in your heart, lungs, or kidneys. These organs may even begin to fail.

Signs and Symptoms of Bleeding

In DIC, the increased clotting activity uses up the platelets and clotting factors in the blood. As a result, serious bleeding can occur. DIC can cause internal and external bleeding.

Internal Bleeding

Internal bleeding can occur in your body's organs, such as the kidneys, intestines, and brain. This bleeding can be life threatening. Signs and symptoms of internal bleeding include:

• Blood in your urine from bleeding in your kidneys or bladder.
• Blood in your stools from bleeding in your intestines or stomach. Blood in your stools can appear red or as a dark, tarry color. (Taking iron supplements also can cause dark, tarry stools.)
• Headaches, double vision, seizures, and other symptoms from bleeding in your brain.

External Bleeding

External bleeding can occur underneath or from the skin, such as at the site of cuts or an intravenous (IV) needle. External bleeding also can occur from the mucosa. (The mucosa is the tissue that lines some organs and body cavities, such as your nose and mouth.)

External bleeding may cause purpura (PURR-purr-ah) or petechiae (peh-TEE-key-ay). Purpura are purple, brown, and red bruises. This bruising may happen easily and often. Petechiae are small red or purple dots on your skin.

Purpura and Petechiae

The photograph shows purpura (bruises) and petechiae (red and purple dots) on the skin. Bleeding under the skin causes the purple, brown, and red color of the purpura and petechiae.

Other signs of external bleeding include:

• Prolonged bleeding, even from minor cuts.
• Bleeding or oozing from your gums or nose, especially nosebleeds or bleeding from brushing your teeth.
• Heavy or extended menstrual bleeding in women.

Source: National Heart, Lung, and Blood Institute, National Institutes of Health

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