• Bleeding, Life-Threatening Internal

    What is Internal Bleeding?

    Internal bleeding (bleeding that occurs inside the body, into a body cavity or space) can be a consequence of traumatic injury and may be life threatening. This includes blunt trauma caused by impact with a flat object or a surface that does not break the skin. Falls, being struck by a vehicle or a piece of heavy equipment, being struck by an object such a bat, or being thrown into a blunt object like a steering wheel are examples. Crushing forces, such as when a person’s body is squeezed between two hard surfaces, can also cause blunt trauma, leading to internal bleeding. Internal bleeding can also be caused by penetrating trauma, such as being pierced by a knife or bullet, or impaled by objects such as a branch or piece of metal.

    Emergency Steps


    Check the scene safety, form an initial impression, obtain consent and put on PPE, as appropriate.


    Check for signs and symptoms.

    • Coughing, vomiting or urinating blood*
    • Tender, swollen or ridged area*
    • Brusing on abdomen, chest or skull*
    • Signs and symptoms of shock*

    *Note: Signs and symptoms with a * require immediate emergency medical treatment.


    Call 9-1-1 and get equipment if the person requires immediate emergency medical treatment.


    Give Care.

    General Care

    1. Position the person as appropriate.
      1. If a head, neck or back injury is suspected, leave in position found unless you must move for safety, to perform CPR or to control bleeding.
      2. If signs and symptoms of shock, have person lie flat on their back unless they prefer a different position for comfort and breathing.
    2. Give care for shock, if necessary.
    3. Stay with them until EMS arrives.
    4. Continue checking them as appropriate to determine if additional care is needed.
    5. Keep them from getting cold or overheated.
    6. Do not give them anything to eat or drink.
    7. Reassure them you will help and that EMS has been called.
    8. Watch for changes in condition, including breathing, and give care as appropriate and trained.

    Life Threatening Internal Bleeding FAQs

    Will internal bleeding be obvious right away?

    Not all the time. While you may see the signs and symptoms quickly after the injury, it may not be immediately obvious. Seemingly minor trauma can cause internal bleeding, and signs and symptoms may not be seen until hours or days after the initial injury. If you think internal bleeding may be present, treat it as a life-threatening emergency.

    What is shock?

    Shock is a progressive, life-threatening condition in which the body does not get enough oxygen-rich blood often due to disturbed blood flow. As a result, organs and body systems begin to fail.

    Signs and symptoms include:

    • Rapid, weak heartbeat
    • Rapid breathing
    • Pale, gray or cool moist skin
    • Altered level of responsiveness
    • Excessive thirst

    Note: If you see any signs and symptoms of shock, call 9-1-1.

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