A patient presents to the emergency department with a deep laceration to the forearm that is actively hemorrhaging. After ensuring the scene is safe and donning personal protective equipment, what is the most appropriate initial sequence of actions to control the bleeding?
Apply a tourniquet 5-8 cm proximal to the wound, then administer pain medication.
Immediately elevate the limb, then apply direct pressure to the wound.
Apply direct pressure to the wound, then elevate the limb above the heart.
Apply pressure to the brachial artery, then prepare for wound irrigation.
The correct initial action for controlling external hemorrhage is to apply firm, direct pressure over the wound. This is the most effective first-line intervention. Elevating the injured limb above the level of the heart is an important adjunctive measure that reduces blood flow to the extremity and should be done in conjunction with direct pressure if there are no contraindications. Applying a tourniquet is a measure used for severe, life-threatening extremity hemorrhage that is not controlled by direct pressure. Applying pressure to an arterial pressure point is a secondary measure used only if direct pressure and elevation fail to control the bleeding.
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Musculoskeletal and Wound Emergencies
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