system
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human
How do surgeons stop internal bleeding?

Movies/TV make it look like treating gun wounds is a matter of removing the bullet and stitching up the wound, even when bleeding heavily. I'm thinking there must be more to it than this, like stitching up insides or something.
gpt
Lots of ways!

As Gestapoparrot, it depends a lot on the nature of the injury. There are lots of haemostatic techniques, which vary in complexity. Loosely, from simple to complicated:

1. Do nothing: Minor haemorrhage in a patient with unimpaired intrinsic haemostasis works surprisingly well for stuff like superficial ooze from solid organs.

2. Direct pressure. Direct pressure on a small bleed with a finger/gauze pad can do wonders. There are also dressings that help improve blood clotting (through the addition of things like calcium, which helps blood clot) which can be also packed in. I've also found soaking gauze with adrenaline (to help contract blood vessels) works, but not sure if it is more effective than gauze alone. If you have a big bleed, direct pressure with a finger or a clamp on the artery further upstream can give you time to mend the defect or prevent exsanguination while you resect the injury if it is not salvagable. Pressure is great.

3. Electrocautery: Diathermy uses heat (from electricity) to fry whatever you're pointing at. Unipolar diathermy has a big pad stuck to one part of the patient, you hold the other end which looks like a pen and electricity flows through from one end to the other. It has a switch on it which you can flick to fry offending bleeders and stray erythrocytes that irk you.

4. Ligation. You can tie a surgical tie around a vessel to stop it bleeding. If you can't see it exactly, you can tie a figure of 8 tie around the area where it is spurting from.

5. Packing. Packing, in simple terms, is stuffing the area full of gauze until bleeding stops. Technically it is a bit more difficult as there are lots of options; you can pack from within an organ, or from without (e.g. if you have a cut through a liver and you can approximate each side you can splint and compress it by packing around the liver).

6. Balloon tamponade. If you have a massive bleed in an appropriate cavity, you can stick a foley catheter or whatever else you have to hand in there and inflate it, putting lots of pressure on the bleeding area. Examples for post-partum haemorrhage (bleeding uterus after delivery) and oesophageal bleeds (where you can put down a device called a blakemore tube to basically compress the oesophagus from within).

7. Formal vascular repair. If you have a big injury to an important vessel, there are no other more pressing issues, and the patient can take it, you can try and formally repair the vessel with a graft or somesuch.

These are a few of the surgical techniques for haemorrhage control. Not all of them are useful in all situations, some take more time than others, some are better as a temporary solution while a definitive one is prepared.

Having a good anaesthetist who keeps the surgeon up to date with the state of the patient and keeps them alive while they are actively trying to die and filled with clotting factors/blood/platelets (so their blood can actually clot) is also essential.