b'Internal BleedingChapterInternal bleeding may be difficult to recognise, but should always be suspected where there are signs and symptoms of shock and following history of an incident or illness. Internal bleeding can result from trauma (fracture), from a ruptured internal organ (spleen) or from medical conditions such as a stomach ulcer. Blood is lost from the circulation internally and shock can develop quickly. Blood can accumulate and exert pressure on the brain and lungs. Treatment for internal bleeding is aimed at making the patient as comfortable as possible and obtaining immediate medical attention -it cannot be controlled by a first aider.How to RecogniseObvious signs and symptoms of shock such as pale, cold and clammy skin,anxiety, restlessness and thirst.Rapid and weak pulse, rapid and shallow breathing, fainting.Nausea and possible vomiting.There may be pain, tenderness or tension over or around theaffected area with visible swelling and discoloration.Appearance of blood from a body opening:bright red, frothy blood coughed up from the lungs.dark brown coffee grounds blood, vomited from the stomach.trickle of blood from the ear or nose after a head injury.passing of blood stained urine or bowel movement.How to ManageConscious PatientCall Ambulance 000 and closely monitor patient for response, airway, normal breathing whilewaiting for Ambulance. Rest the patient in a position of comfort, ideally lying down. This helps improve blood supply to the vital organs and minimises shock. Loosen any tight clothing around the neck, chest and waist to reduce constriction and to help breathing. Administer oxygen if you are trained in its use.Keep the patient covered, warm and reassured.Do not give the patient anything to eat or drink as surgery may be required in which case it isimportant to reduce the risk of vomiting under anaesthesia. You may moisten the lips as the patient may be complaining of thirst.70 Bleeding'