Internal Bleeding

Internal bleeding may be difficult to recognise but should always be suspected where there are signs and symptoms of shock.

Internal bleeding includes bruising, locally contained bleeding (e.g., an “egg on the head”) and the bleeding associated with injury or disease of organs in the abdomen or chest, as well as fractures.

Severe bleeding may also occur from complications of pregnancy.

Signs and symptoms may include:

  • Pain, tenderness or swelling over or around the affected area.
  • The appearance of blood from a body opening, e.g.:
    • bright red and/or frothy blood coughed up from the lungs.
    • vomited blood which may appear bright red or as dark brown “coffee grounds”.
    • blood-stained urine
    • vaginal bleeding or bleeding from the penis
    • rectal bleeding which may be bright red or black and “tarry”.
  • Shock in the case of severe bleeding


Severe internal bleeding is life-threatening and requires urgent treatment in hospital.

  • Send for an ambulance.
  • Lie the person down.
  • Treat shock.

Closed Bleeding in a Limb

If there is bruising to a limb and no external bleeding, we suggest using pressure and a cold pack if available.

If closed bleeding in a limb is causing severe swelling or pain, or the person is showing signs of shock, send for an ambulance.

Management of ALL Severe Bleeding

  • Call for an ambulance.
  • Reassure the person.
  • Assist the person into a position of comfort, preferably lying down.
  • Keep the person warm.
  • Monitor the vital signs at frequent intervals.
  • Administer oxygen if available and trained to do so.
  • DO NOT give any food or drink orally, including medications.
  • Treat shock
  • If the person is unresponsive and not breathing normally, follow DRSABCD.