In pediatric trauma care, which action is most appropriate when a calf laceration is bleeding heavily?

• A. Apply a tourniquet
• B. Apply a sterile dressing and pressure only
• C. Ice the area and immobilize
• D. Massage away the blood flow

Answer: (A)

Managing life-threatening bleeding in a limb starts with stopping the blood loss as quickly as possible. When a calf laceration is bleeding heavily, a tourniquet is the most effective option to rapidly control arterial and profuse venous bleeding when direct pressure with a dressing cannot keep bleeding under control or when transport to definitive care will be delayed. Begin with firm direct pressure using a sterile dressing, but if bleeding persists or is unstoppable, apply a tourniquet proximal to the wound (about 2 inches or so above, not over a joint), tighten until bleeding stops, and secure it. Note the time of application and continually monitor distal perfusion and sensation. Do not massage the area, and avoid relying on ice alone or immobilization as the sole measure, because these do not stop heavy hemorrhage. A tourniquet, used correctly, provides decisive hemorrhage control and buys time for further care.