NREMT Paramedic Cognitive ExamTraumaMedium
A 22-year-old male sustains a deep laceration to his right forearm from a broken window. Bright red blood is spurting rhythmically from the wound. Direct pressure has been applied but bleeding continues. What is the next most appropriate step to control the hemorrhage?
- AApply a pressure dressing over the wound
- BElevate the extremity above the level of the heart
- CApply ice packs to the wound site
- DApply a tourniquet proximal to the wound
Show answer & explanationAnswer & explanation
Correct answer: D. Apply a tourniquet proximal to the wound
Bright red, spurting blood indicates arterial bleeding. If direct pressure is insufficient, the next definitive step to control severe, life-threatening extremity hemorrhage is the application of a tourniquet proximal to the wound.
Why the other options are wrong
- A. A pressure dressing is part of direct pressure. If direct pressure is failing, a pressure dressing alone is unlikely to be sufficient.
- B. Elevation can help with venous bleeding, but it is generally ineffective for strong arterial hemorrhage that is resistant to direct pressure.
- C. Ice packs can cause vasoconstriction but are not a primary or effective method for controlling severe arterial hemorrhage.
Hemorrhage Control Steps
A systematic approach to stop bleeding, progressing from least to most invasive: direct pressure, pressure dressing, tourniquet, and sometimes hemostatic agents.
- Direct pressure is the first and most effective step for most bleeding.
- Tourniquets are for severe, life-threatening extremity bleeding refractory to direct pressure.
- Arterial bleeding is characterized by bright red, spurting blood.
Memory trick: Direct, Dress, Turn, Pack