Version July 2025
The management of compressible hemorrhage is reviewed in this algorithm. For the management of noncompressible hemorrhage (zone III neck, chest, abdomen, pelvis), refer to other UpToDate content.
The approach to compressible external hemorrhage shown in the algorithm can apply to a variety of care settings such as in the field or the hospital setting (eg, emergency department, ward, operating room); however, available equipment and supplies vary. The ideal materials to use are provided in the algorithm; alternatives can be used (eg, standard gauze if hemostatic gauze is not available). A lack of any of the suggested supplies should not deter an attempt to control bleeding.PPE: personal protective equipment.
* A kit may be available in public facilities as part of the Stop the Bleed initiative. Refer to inset for general contents.
¶ In the hospital setting, PPE should ideally include a mask with a face shield, an impervious gown, gloves, and shoe covers. In other settings, use any that are available.
Δ Reassess control of hemorrhage frequently, particularly after any patient transfer (eg, to/from stretcher) and during transport (eg, to hospital, to operating room). Definitive control of bleeding depends on the injury and may occur in the emergency department (eg, severe scalp laceration), in the operating room, or in an interventional suite. Surgical consultation is important to help determine the best setting and facilitate coordination of care.
◊ Bleeding in zone III is considered noncompressible and not covered in this algorithm. Refer to UpToDate content discussing noncompressible hemorrhage.
§ Inject lidocaine with epinephrine into the wound, if available, to reduce bleeding and pain.
¥ Ideally, the patient should be transferred to a facility equipped with a hybrid operating room for control of neck bleeding, either operatively or using endovascular techniques.
‡ A commercial tourniquet is preferred. A pneumatic blood pressure cuff is an alternative. Improvised tourniquets are discouraged but may be the only option. An improvised tourniquet should be replaced as soon as feasible with a commercial tourniquet.