From the Guidelines
The initial management for a victim with a thigh stab wound causing profuse femoral artery bleeding should be direct pressure above the bleeding point or application of a tourniquet around the wound (option A). This approach is supported by the most recent and highest quality study, which emphasizes the importance of immediate hemorrhage control in trauma management 1. The European guideline on management of major bleeding and coagulopathy following trauma recommends local compression to limit life-threatening bleeding and suggests the use of a tourniquet as an adjunct in the pre-surgical setting 1.
The MARCH algorithm (Massive hemorrhage, Airway, Respiration, Circulation, Head injury/Hypothermia) prioritizes controlling life-threatening hemorrhage, making direct pressure or tourniquet application the first step in management. Although the patient has stable vital signs (BP 100/70, pulse 80, saturation 97%), uncontrolled femoral artery bleeding can rapidly lead to hemorrhagic shock and death.
Other studies, such as those published in 2024 and 2021, also support the importance of immediate hemorrhage control and the use of tourniquets in severe limb trauma 1. However, the 2023 European guideline provides the most recent and comprehensive recommendations for managing major bleeding and coagulopathy following trauma, making it the primary reference for this scenario 1.
Key points to consider in the management of this patient include:
- Immediate control of bleeding using direct pressure or a tourniquet
- Rapid transportation to the operating room for definitive vascular repair
- Maintenance of other aspects of resuscitation, including fluid management and monitoring of vital signs
- Consideration of the patient's overall clinical status and potential for complications, such as hemorrhagic shock or coagulopathy.
By prioritizing immediate hemorrhage control and following the recommendations outlined in the most recent and highest quality study, the patient's morbidity, mortality, and quality of life can be optimized 1.
From the Research
Initial Management of Thigh Stab Wound with Femoral Artery Bleeding
- The patient's condition is critical, with active profuse femoral artery bleeding, but is fully conscious with stable vital signs (saturation 97% on room air, blood pressure 100/70, pulse 80) 2.
- The first priority in managing this patient is to control the bleeding, as blood loss from a major arterial source can rapidly lead to exsanguination and death 2.
- Direct pressure remains the most effective "medical" intervention for initial hemorrhage control, and should be applied above the oozing point to control bleeding 2.
- A tourniquet may also be considered, but its application should be done with caution and only if direct pressure is not effective in controlling the bleeding 2.
- Elevating and splinting the affected limb may also be helpful in controlling the bleeding, but this should be done in conjunction with direct pressure 2.
Comparison of Resuscitation Strategies
- The use of hypotensive resuscitation (permissive hypotension) has been shown to be effective in reducing mortality and morbidity in trauma patients with hemorrhagic shock 3, 4, 5, 6.
- Hypotensive resuscitation involves limiting fluid resuscitation to maintain a lower-than-normal blood pressure until operative control of the bleeding can occur 3, 4, 5, 6.
- This approach has been shown to reduce blood loss, hemodilution, ischemia, and hypoxia in tissues, and may offer a survival benefit over conventional resuscitation strategies 4, 5, 6.
- However, the optimal parameters for hypotensive resuscitation are still unclear and require further research 3, 4, 5, 6.