The average person has five litres of blood in the circulation and loss of more than about 30% of this can make people very unwell.
Internal bleeding is like turning on a tap and it is often some time before the tank is sufficiently empty to cause problems or signs of blood loss. It is unlikely to be present if you respond to an injured player immediately after injury. But haemorrhagic shock may be present at the end of the match or half time, in someone who came off injured. The younger and fitter you are, the more able your system is to cope with blood loss before you become unwell, so they may look “well” for some time before rapidly and suddenly becoming very unwell and looking obviously “shocked”.
With not enough blood in the system, the skin may appear pale as the body tried to divert it to the other organs and is classically described as “clammy” (although this may be of limited benefit in a recently exercising sweaty athlete.) If the brain fails to get enough blood, the player may feel faint or lose consciousness, or simply appear confused. The lungs may be working harder to try and get more oxygen to the tissues. Clues as to where the blood loss has occurred may be evident such as persistent abdominal pain, or chest pain and evidence of rib fractures, etc.
The take home message for the first responder is to consider shock as a marker of serious injury and recognise the need for immediate transfer to hospital.
Signs of haemorrhagic shock
- Pale and clammy (not enough blood in circulation).
- Signs of organs under stress (brain – confusion; lungs - breathing fast).
- Clues as to where the blood may be (pain in abdomen, chest movement asymmetrical).