Each year, about 60,000 Americans die from hemorrhaging, or blood loss, a 2018 review estimates.

Worldwide, that number is almost 2 million. As many as 1.5 million of these deaths are the result of physical trauma.

Although injury is often associated with visible wounds, you can bleed to death (exsanguination) without ever seeing a drop of blood.

Keep reading to learn how to recognize the signs of internal bleeding, how to stop external bleeding until help arrives, what it feels like to go into hemorrhagic shock, and more.

Bleeding to death may not be painful, but the initial injury can be.

For example, if you’re injured in a car accident, you may experience great pain from cuts or crush injuries. You may begin bleeding as a result of the injuries. This blood loss may not cause any more pain than the injuries.

However, as blood loss increases, you’ll begin experiencing signs and symptoms of hypovolemic shock, or hemorrhagic shock. Hemorrhagic shock is a life-threatening condition. It occurs when your body loses a lot of blood quickly.

Mild symptoms of hemorrhagic shock include:

  • dizziness
  • sweating
  • fatigue
  • nausea
  • headache

Symptoms will become more severe as blood loss increases. These symptoms include:

  • pale skin
  • cold or clammy skin
  • rapid heart rate
  • weak pulse
  • rapid, shallow breathing
  • lightheadedness
  • dizziness
  • confusion
  • loss of consciousness

Bleeding to death can happen very quickly. If the hemorrhaging isn’t stopped, a person can bleed to death in just five minutes. And if their injuries are severe, this timeline may be even shorter.

However, not every person who bleeds to death will die within minutes of the start of bleeding. If you have a clotting problem or a slow internal bleed, for example, it can take days for the blood loss to be severe enough to cause hemorrhagic shock.

The amount of blood you have in your body depends on your age and size. The National Institutes of Health say a 154-pound man has between 5 and 6 liters of blood in his body. A smaller woman might have between 4 and 5 liters in her body.

Hemorrhagic shock begins when you lose about 20 percent, or one-fifth, of your body’s blood or fluid supply. At this point, your heart isn’t able to pump sufficient amounts of blood through your body.

You reach exsanguination when you lose 40 percent of your body’s blood or fluid supply. This condition can be fatal if the bleeding isn’t stopped and treated quickly.

The average woman loses 60 milliliters — about 2 ounces — of blood during her period. Women with heavier periods (menorrhagia) typically lose 80 milliliters (2.7 ounces) of blood.

Although this may seem like a lot, the human body holds more than 1 gallon of blood. Losing a couple of ounces during your menstrual cycle isn’t enough to cause complications or result in exsanguination.

If you’re concerned about blood loss from your menstrual period, see your doctor. They can determine whether your bleeding is consistent with menorrhagia or if your symptoms are tied to another underlying condition.

Treatment can help reduce bleeding and may make symptoms easier to manage.

Injuries that can cause you to bleed to death include:

  • crush injuries from car accidents or a heavy object falling on you
  • gunshot wounds
  • stab or puncture wounds from a needle or knife
  • hematoma (a collection of blood, such as a clot, outside of a blood vessel)
  • cuts or abrasions to internal organs
  • cuts or lacerations to the skin
  • blunt force trauma from impact with an object

You don’t have to see blood leave your body to bleed to death. Internal bleeding can also be fatal.

Internal bleeding can result from:

  • a crush injury
  • blunt force trauma
  • an abrasion or cut to an internal organ
  • a torn or ruptured blood vessel
  • an aneurysm
  • a damaged organ

Symptoms of internal bleeding aren’t always easy to identify. They often go unnoticed, especially if blood loss is slow.

Seek immediate medical attention if you notice:

  • blood in urine
  • blood in stool
  • black or tarry stool
  • vomiting blood
  • chest pain
  • abdominal swelling
  • abdominal pain
  • vomiting blood

If you or someone around you is experiencing severe external bleeding, call 911 or your local emergency services right away.

In most cases, emergency services will keep you on the phone until help arrives. They may also advise you on how to minimize the bleeding.

They may ask you to:

  • Raise or elevate any injured body part, except the head. Don’t move people who have injuries to their legs, back, neck, or head.
  • Apply medium pressure to the wound with a clean cloth, bandage, piece of clothing, or your hands. Don’t apply pressure to eye injuries.
  • Lie down — or help the injured person lie down — if possible. If you faint, you’re less likely to develop additional injury because you’re unable to fall.
  • Do your best to remain calm. If your heart rate and blood pressure rise, the speed of blood loss will increase, too.

When emergency personnel arrive, provide as much information as you can about what happened and what you’ve done to stop the flow of blood from the wound.

If you’re speaking on behalf of someone who’s injured, let first responders know what happened and what you’ve done to provide aid. Also share any additional information that you know about their medical history, including chronic conditions or drug allergies.

The window for treatment and survival falls into three categories: minutes, hours, and days.

More than half of people with traumatic injuries, including hemorrhaging, die within minutes of the accident or injury.

A 2013 review estimates about 30 percent of deaths from traumatic injury occur within the first 24 hours of injury.

It isn’t common, but it’s possible to survive the initial injury yet die as a result days or weeks later. This accounts for 9 percent of trauma-related deaths.

If you’re able to get treatment, your outlook improves. The faster you can receive help, the greater your chance of surviving.

The first lines of treatment focus on stopping the bleeding and preventing additional blood loss. If you’ve lost enough blood, doctors may try to replace some of it with a transfusion or other intravenous (IV) fluid supply. You may also receive additional transfusions later.

Once the bleeding stops, your body will naturally begin to repair shock-related damage and help restore your blood supply.

In many ways, your body is capable of handling the repair from hemorrhagic shock by itself. However, medication and other therapies can help the process along.

Certain medications, for example, can help boost your heart’s pumping power and improve circulation.

Organ damage may not be reversible, so a full recovery may not be possible.

Bleeding to death isn’t common. Not everyone who loses large amounts of blood will die as a result of the blood loss. How well you recover from the injury and blood loss depends largely on how quickly you get medical attention, how much blood loss you experienced, and how severe the damage was.