Is gauze soaked in adrenaline (epinephrine) effective for hemorrhage control?

Gauze Soaked in Adrenaline for Hemorrhage Control

Gauze soaked in adrenaline (epinephrine) is NOT recommended for hemorrhage control—there is no evidence supporting its use, and standard hemostatic dressings (such as chitosan-coated or kaolin-impregnated gauze) combined with direct pressure are the evidence-based interventions when direct pressure alone fails. 1

Why Adrenaline-Soaked Gauze Is Not Recommended

• No evidence exists in any international first aid or trauma guidelines supporting the use of epinephrine-soaked gauze for external hemorrhage control 1
• The 2020 International Consensus on First Aid Science specifically reviewed hemostatic agents and dressings but makes no mention of topical epinephrine as a hemorrhage control method 1
• Epinephrine causes vasoconstriction, but this mechanism is unreliable for controlling significant external bleeding where mechanical pressure and clot formation are the primary determinants of hemostasis 1

What Actually Works: Evidence-Based Hemorrhage Control Algorithm

Step 1: Direct Manual Pressure (First-Line)

• Apply firm, continuous direct pressure over the bleeding site for at least 10-15 minutes without interruption 2, 3
• This remains the foundation of hemorrhage control and stops bleeding in the majority of cases 1, 2
• Do not remove dressings to check if bleeding has stopped, as this disrupts clot formation 2

Step 2: Hemostatic Dressings + Direct Pressure (When Standard Pressure Fails)

• Apply a hemostatic dressing (chitosan-coated gauze or kaolin-impregnated gauze) directly to the bleeding surface while maintaining pressure 1, 2
• Hemostatic dressings achieve cessation of bleeding within 5 minutes in 51.2% of cases compared to 32.5% with pressure alone 1
• These dressings work by concentrating clotting factors and providing a scaffold for platelet aggregation, achieving hemostasis in 90.8% of severe bleeding cases 2
• The American Heart Association recommends hemostatic dressings when standard first aid hemorrhage control cannot control severe external bleeding 1

Step 3: Pressure Dressing Application

• Once initial hemostasis is achieved, apply an elastic adhesive bandage over gauze pads to maintain hemostatic pressure 1, 2, 3
• This prevents re-bleeding and maintains the clot 1, 3

Step 4: Tourniquet (For Limb Hemorrhage Only)

• If bleeding continues despite hemostatic dressing application and sustained pressure for 10-15 minutes on an extremity, apply a manufactured tourniquet proximal to the wound 1, 2
• Tourniquets are preferable to hemostatic dressings for severe limb hemorrhage when both are available 1
• Never use narrow or improvised tourniquets, as these cause more tissue damage 2

Specific Hemostatic Dressings With Evidence

Recommended Agents:

• QuikClot Combat Gauze (kaolin-impregnated): Most efficacious hemostatic dressing in human blood studies and the US military's first-line agent 4, 5, 6, 7
• Chitosan-coated gauze: Achieves hemostasis within 5 minutes in 51.2% of cases 1
• Celox Gauze (chitosan-based): Second most efficacious after QuikClot Combat Gauze 6

Not Recommended:

• QuikClot ACS+ (older generation): Clearly outperformed by modern gauze-based hemostatic dressings 6
• Adrenaline/epinephrine-soaked gauze: No evidence base 1

Critical Pitfalls to Avoid

• Do not use topical epinephrine for external hemorrhage control—it lacks evidence and diverts attention from proven interventions 1
• Do not remove initial dressings to check bleeding status, as this disrupts clot formation 2
• Do not delay emergency transport while attempting multiple interventions—hospital-based interventions may be necessary 2
• Do not apply tourniquets to non-extremity bleeding (neck, axilla, groin)—use hemostatic dressings instead 1

When to Escalate Care

• Activate emergency medical services immediately if bleeding continues despite hemostatic dressing application and sustained pressure for 10-15 minutes 2
• Persistent bleeding despite proper interventions warrants investigation for underlying vascular pathology, coagulation disorders, or need for surgical control 3

Special Considerations

• Hemostatic dressings are particularly advantageous in difficult body locations (neck, axilla, groin) where tourniquets cannot be applied 1, 8
• Complications from hemostatic dressings occur in only 3% of cases 1
• The benefits of hemostasis outweigh the risks of infection or burns from hemostatic agents 1
• Proper training in hemostatic dressing application techniques is required for effective use 1