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Junctional haemorrhage — DIPIMC MCQ

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HardPre-Hospital TraumaJunctional haemorrhageDIPIMCDipIMC

A 24-year-old motorcyclist has struck a kerb at speed. On the roadside you find brisk, pulsatile bleeding from a deep wound in the right groin at the junction of the thigh and pelvis. A limb tourniquet applied as high as possible on the thigh has not controlled the bleeding, and blood continues to pool rapidly. What is the most appropriate immediate action?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Pack the wound firmly with a haemostatic gauze and apply sustained direct pressure

Junctional haemorrhage at the groin is proximal to any site a limb tourniquet can occlude, so wound packing with a haemostatic dressing and firm, sustained direct pressure is the priority under the catastrophic-haemorrhage step of the CABCDE approach. Repositioning or doubling a limb tourniquet cannot compress a junctional vessel. Fluids should not precede haemorrhage control, and a binder placed at the iliac crests is both mis-sited and ineffective for this wound. Pearl: a junctional tourniquet or improvised packing buys time to a major trauma centre.

Reference: JRCALC Clinical Guidelines; NICE NG39 (Major Trauma)