Severe bleeding from an arm wound can kill within minutes, so stopping it comes before almost everything else, even the airway. Firm direct pressure, wound packing and a tourniquet placed above the wound are the main tools.
Key symptoms
- Spurting or steady flow of bright or dark red blood
- Blood pooling on the ground or soaking clothes and bandages
- Pain, numbness or a missing part of the arm
- Dizziness, thirst and anxiety as blood is lost
- Confusion or fainting in late shock
What you find on exam
- Find the bleeding source fast; expose the whole arm
- Signs of shock: fast pulse, pale cool skin, slow refill, low blood pressure
- Pulse, sensation and movement below the wound
- Mechanism: glass, machinery, gunshot or amputation
- Other injuries on a full trauma survey
Tests
- Repeat vital signs every 5 minutes
- Check that bleeding stops and the pulse below disappears after a tourniquet
- Hospital: blood count, type and crossmatch, lactate
- X-ray or CT angiography for bone or artery injury
Treatment basics
- Firm direct pressure on the wound at once
- Tourniquet 2 to 3 inches above the wound, not over a joint, tightened until bleeding stops; write the time
- A second tourniquet above the first if bleeding continues
- Pack deep wounds with hemostatic gauze and hold pressure for at least 3 minutes
- Keep the patient warm, limit IV fluids and transport fast to a trauma center
Red flags
- Bleeding that soaks through dressings
- Signs of shock
- Amputation or bleeding near the armpit where a tourniquet cannot reach
Practice it in Making Synapses
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic); National EMS Education Standards (2021). Written by Making Synapses. Making Synapses is not affiliated with these organizations.