Hemorrhage Control and Wound Management

1. Where This Starts: Reading the Bleed Before You Treat It

Bleeding is not one thing. It comes from three different kinds of vessels. Each one bleeds differently, and each one tells you something different about how urgent it is.

Capillary bleeding oozes from the smallest vessels, right under the skin. It's minor, and gentle pressure stops it fast.

Venous bleeding comes from a vein, carrying blood back to the heart under low pressure. So it flows steadily instead of spurting.

Arterial bleeding comes from an artery, carrying blood away from the heart under the full force of each heartbeat. So it's pulsatile, spraying in time with the pulse. It's the one that's hard to control and kills fastest.

Classification	Source	Characteristics	Treatment priority
Minor (capillary)	Skin, small vessels	Slow ooze, red, stops with gentle pressure	Low — pressure and a bandage
Moderate (venous)	Small-medium veins	Steady flow, dark red, controllable with pressure	Medium — direct pressure, pressure dressing
Severe (arterial)	Arteries, large vessels	Pulsatile spray, bright red, hard to control	High — direct pressure, tourniquet without delay if not controlled
Internal	Deep tissues, organs, body cavities	Little or no external bleeding; shock, distension	High — oxygen, position, transport; no field intervention

There's a fourth category, and it's the one that gets missed: internal bleeding. Nothing is visible outside, so there's no wound to point you at it. A patient in shock with no visible injury is bleeding somewhere you can't see — treat that the same as any shock: oxygen, position, warmth, transport.

So before you touch a dressing, you're reading two things: can you control this at the surface, and does the shock picture say there's more happening underneath?