55.1 Immediate treatment for a severely bleeding wound

Preventing a patient’s blood from leaving his circulation is one of the most urgent surgical tasks. He can lose a litre or more internally into his peritoneal (66.1) or pleural cavities (64.5), or around broken bones (76.1, 78.4). External bleeding is much easier to diagnose and stop. The most useful methods are to raise the wound and to press on it. The least useful method is a tourniquet. So when you teach first aid workers, stress the value of local pressure from a firm pack in the wound, combined with pressing firmly on the pressure points when necessary. Many surgeons feel that a tourniquet is so dangerous that no first aid worker should ever use one—you will however find a pneumatic tourniquet invaluable in the theatre (3.8).