NREMT Emergency Medical Technician (EMT) Cognitive ExamTraumaMedium
A 28-year-old construction worker has sustained a deep laceration to his inner thigh from a piece of rebar. You observe dark red blood flowing steadily from the wound. Direct pressure has been applied for 5 minutes, but the bleeding continues. Which of the following is the MOST appropriate next step in managing this patient's bleeding?
- APack the wound with hemostatic gauze.
- BApply a pressure dressing over the wound.
- CElevate the injured limb above the level of the heart.
- DApply a tourniquet proximal to the wound.
Show answer & explanationAnswer & explanation
Correct answer: B. Apply a pressure dressing over the wound.
After direct pressure fails to control bleeding, applying a pressure dressing is the next logical and essential step to maintain continuous pressure on the wound. This is a common and effective method for controlling venous or capillary bleeding, and sometimes even moderate arterial bleeding, that doesn't immediately stop with direct pressure alone.
Why the other options are wrong
- A. Hemostatic gauze is used for severe, uncontrollable bleeding, particularly in areas where a tourniquet cannot be applied or as an adjunct when other methods fail. While effective, applying a standard pressure dressing is the more immediate and widely applicable next step for persistent bleeding after direct pressure.
- C. Elevation can help reduce venous pressure and bleeding but is usually used in conjunction with direct pressure or a pressure dressing, not as a standalone next step when direct pressure has failed.
- D. A tourniquet is generally reserved for severe, life-threatening arterial bleeding that cannot be controlled by other means, or for amputations. Steady dark red flow is more indicative of venous bleeding.
Bleeding Control Progression
The standard progression for controlling external bleeding involves several steps, starting with the least invasive and moving to more aggressive interventions if bleeding persists. This ensures effective control while minimizing potential complications.
- Direct pressure is first step.
- Pressure dressing follows if direct pressure fails.
- Tourniquet for severe, uncontrolled arterial bleeding.
Memory trick: Press, Dress, Tourniquet to Rest.