Junctional haemorrhage — DipIMC MCQ

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EasyTraumaJunctional haemorrhageDipIMC

A 34-year-old forestry worker has a chainsaw injury high in the groin. Direct pressure briefly slows the bleeding, but blood pools again when pressure is eased and a limb tourniquet cannot sit above the wound. What is the most appropriate immediate action?

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Correct answer: B — Pack the wound with haemostatic gauze and maintain firm pressure

Explanation lettering: C = shown as A · E = shown as B · D = shown as C · A = shown as D · B = shown as E

E is correct: Junctional bleeding requires wound packing with a haemostatic dressing and sustained pressure because a standard limb tourniquet is not anatomically effective. A is less suitable because it does not address the discriminator in the vignette; B is less suitable because it creates avoidable delay in a time-critical presentation; C is less suitable because it moves the patient before the decisive threat or destination issue is addressed; D is less suitable because it does not address the discriminator in the vignette. The most tempting alternative is therefore suboptimal because it either delays the time-critical pre-hospital intervention or sends the patient to the wrong level of care. The key DipIMC principle is focused cABCDE decision-making with early pre-alert, triage or retrieval escalation when the scene physiology demands it.

Reference: JRCALC Guidelines; NICE Major Trauma NG39; ATACC