Uncontrolled hemorrhage remains one of the leading causes of preventable trauma death. Early recognition of severe bleeding is critical because patients can rapidly deteriorate and progress to hemorrhagic shock if bleeding is not controlled.

Hemorrhage may be external, internal, or both. While external bleeding is often obvious, internal bleeding can be more difficult to identify and may require providers to rely on mechanism of injury, patient presentation, and assessment findings.

Signs of significant hemorrhage may include:

• Visible severe bleeding
• Expanding hematomas
• Blood pooling beneath the patient
• Altered mental status
• Pale, cool, or clammy skin
• Tachycardia
• Weak or absent peripheral pulses
• Signs of shock

During the trauma assessment, providers should actively look for sources of life-threatening bleeding and intervene immediately when identified. Hemorrhage control takes priority because a patient can bleed to death long before other injuries become fatal.

Remember: Bleeding that is not recognized cannot be controlled. Find it. Fix it.