Stopping external bleeding in the neck

Authors: Simulation and Certification Center

Editor: Rednenko V.V.

Clinical situation:  

You have witnessed a person fall on an icy sidewalk. The victim fell onto a metal fence and received a cut wound to the neck. The injured person is conscious, sitting near the fence and trying to close the wound on his neck with his palm. Blood seeps through the victim's fingers. The victim calls for help. 
The scene is safe. A vehicle first aid kit is available for your use. 

Equipment for the practical skill:

• simulator;
• vehicle first aid kit.

The procedure for performing a practical skill

• Call for help:
  • ask an eyewitness to call an ambulance and report an accident with a victim;
  • ask the bystander to bring you a vehicle first aid kit;
  • ask the bystander to assist you in providing first aid.
• Make sure the scene is safe.
• Identify a type of the external bleeding:
  • visualize the wound;
  • verify the bleeding;
  • choose a way to stop the bleeding.
• Since the victim is conscious, obtain informed consent to the procedure:
  • give all the information to the person about what the procedure involves, including the benefits and risks, whether there are reasonable alternative, and what will happen without this procedure;
  • explain what you are going to do;
  • ask the patient to consent to procedure.
• Take from the first aid kit protective gloves and put on it (if it is possible).
• Immediately grab with your hand the patient clothing collar near the wound on the neck and press it on the wound; in the absence of clothing, press down on the neck wound with your hand.

• Press down for wound firmly to provide hemostasis and prevention of the air embolism.
• Form the pressure element (dressing) like a pad of the required size.
• Put this pressure dressing on the bleeding surface of the wound over the first (clothing) layer.

• Press down firmly to provide hemostasis.
• Take the tourniquet and put it above the pressure dressing.

• Bring the free end of the tourniquet to the opposite side in the armpit (axillary fossa).

• Stretch the tourniquet with both hands so it pressed the compressive dressing to the neck wound.
• Secure two ends of the tourniquet with locking elements (buckle) or by tying ends of the tourniquet.

• Make sure that the bleeding has stopped. If necessary, place dressings under the tourniquet (cotton-gauze pads, bandages, rolls of cloth) on top of the existing ones to increase pressure on the wound and to provide hemostasis.
• Ask the person about the presence of painful sensation from the pressure of the tourniquet in the armpit and, if it presents, place a soft pad between the tourniquet and the skin in this place.
• Monitor vital signs – level of response, breathing, and pulse – while waiting for help.