How to manage a 1cm radial side laceration with uncontrolled bleeding from a knife in the ED?

Management of 1cm Radial Side Laceration with Uncontrolled Bleeding in the ED

Direct manual pressure should be applied immediately to control the uncontrolled bleeding from the 1cm laceration on the radial side of the wrist. 1

Initial Management

• Apply direct manual pressure to the bleeding site until bleeding stops - this is the standard first-line method for controlling external bleeding 1
• Use gauze or clean cloth when applying pressure to the wound 1
• If bleeding continues, do not remove the initial gauze; add more gauze on top and continue applying firm pressure 1
• Apply local cold therapy (such as an ice pack) to the wound area to help control bleeding 1

If Direct Pressure Fails

• If direct manual pressure is ineffective in controlling the bleeding, consider using a hemostatic dressing as an adjunctive therapy 1
• Hemostatic dressings have been shown to improve the effectiveness of direct manual pressure and result in a shorter time to hemostasis than standard dressings 1, 2
• Proper application of hemostatic dressings requires training 1

Pressure Dressings

• Once bleeding has been controlled with direct pressure, apply a pressure dressing to maintain bleeding cessation 1
• An elastic bandage can be wrapped firmly over gauze to hold it in place with pressure if continuous manual pressure cannot be maintained 1

Tourniquet Use (If Above Methods Fail)

• If standard hemorrhage control methods (direct pressure, hemostatic dressings) fail to control severe bleeding, consider tourniquet application 1
• A tourniquet should only be used for life-threatening extremity bleeding that cannot be controlled by other methods 1
• Commercial tourniquets are superior to improvised ones 1
• If using an improvised tourniquet, it should be at least 2 inches wide 1
• Document the time of tourniquet application and communicate this to other healthcare providers 1
• Tourniquets should be left in place until surgical control of bleeding is achieved, but time to removal should be shortened as much as possible to minimize complications 3

What Not To Do

• Do not use pressure points or elevation of the extremity to control bleeding, as these methods are not effective and may delay proper treatment 1
• Avoid applying circumferential compressive bandages too tightly around the wrist as this may restrict circulation 4

Additional Considerations

• For a 1cm laceration with uncontrolled bleeding, evaluate for potential damage to underlying structures (tendons, nerves, or blood vessels) 5
• Once bleeding is controlled, the wound should be thoroughly cleaned and properly closed 5
• Provide tetanus prophylaxis if indicated based on immunization status 5

Follow-up Care

• After initial control of bleeding, the wound will require proper closure (sutures, tissue adhesives, or wound adhesive strips depending on the characteristics of the laceration) 5
• Wounds heal better in a moist environment, so consider occlusive or semi-occlusive dressings 5
• Monitor for signs of infection or complications during healing 5