Management of the Mangled Extremity

Annotation for Point B

If external bleeding cannot be controlled or the patient remains unstable without other source despite adequate efforts in the emergency department, the patient should be taken expeditiously to the operating room for surgical control of bleeding. If the patient has concomitant intracavitary hemorrhage, it may be advantageous to use two operative teams. If not, tourniquet use may temporarily control extremity hemorrhage until cavitary sources of ongoing blood loss are managed. Initial control of truncal hemorrhage using damage control techniques will allow the extremity to be addressed as early as possible.

Level of Supporting Evidence: Level 4