Despite direct pressure, a large laceration to the medial aspect of the arm continues to bleed profusely. You should:

• A. pack the inside of the laceration with sterile gauze.
• B. locate and apply pressure to the brachial artery.
• C. continue direct pressure and elevate the extremity.
• D. quickly apply a tourniquet proximal to the injury.

Answer: (D)

When bleeding from a limb is life-threatening and cannot be controlled with direct pressure, the next step is to stop arterial inflow by applying a tourniquet proximal to the injury. A large arm laceration can keep bleeding profuse because pressure at the wound isn’t enough to compress all the vessels feeding it. A tourniquet works by occluding blood flow to the entire distal limb, which rapidly reduces or stops the hemorrhage and buys time for definitive care. Elevation helps with less severe bleeds but won’t fix a high‑flow arterial bleed like this, and trying to press directly on the brachial artery is impractical and less reliable in the field. Packing the wound may reduce surface bleeding, but it won’t reliably halt deep arterial hemorrhage in a large laceration. Place the tourniquet on the arm above the wound, tighten firmly until bleeding stops or is markedly reduced, and continue transport while noting the time of application.