A gang member with a heavy neck wound is bleeding heavily. His airway is patent and breathing is adequate. You should immediately:

• A. Apply a tight pressure dressing and secure it in place with tape.
• B. Apply high-flow oxygen via a nonrebreathing mask at 15 L/min.
• C. Cover the wound with an occlusive dressing and apply direct pressure.
• D. Perform a head-to-toe assessment to find and treat other injuries.

Answer: (C)

When a patient has a heavy neck wound, the immediate threat is massive external hemorrhage. The airway is currently open and breathing is adequate, so the priority is to stop the bleeding right away. Direct pressure on the wound physically compresses the injured vessels, helping to slow or stop the blood loss. Adding an occlusive dressing creates a seal around the wound, which not only helps tamponade bleeding but also minimizes air entry through the neck wound, reducing risks associated with a severe penetrating injury.

Oxygen support, while important, should not delay bleeding control, and a full head-to-toe assessment would take valuable time when a life-threatening bleed is ongoing. A tight pressure dressing alone may not reliably seal the wound, whereas combining direct pressure with an occlusive dressing provides both hemostasis and wound sealing, making it the best immediate action.