HOW TO TREAT A BULLET OR KNIFE WOUND
Do not immediately pull out any impaled objects.
Bullets, arrows, knives, sticks, and the like cause pen-
etrating injuries. When these objects lodge in the vital
areas of the body (the trunk or near nerves or arter-
ies) removing them may cause more severe bleeding
that cannot be controlled. The object may be pressed
against an artery or other vital internal structure and
may actually be helping to reduce the bleeding.
Control the bleeding by using a combination of
direct pressure, limb elevation, pressure points, and
tourniquets (in that order).
DIRECT PRESSURE. You can control most bleeding by
placing direct pressure on the wound. Attempt to
apply pressure directly to bleeding surfaces. The scalp,
for instance, bleeds profusely. Using your fingertips to
press the edges of a scalp wound against the underly-
ing bone is more effective than using the palm of your
hand to apply pressure over a wider area. Use the tips
of your fingers to control bleeding arterioles (small
squirting vessels).
TOURNIQUETS. A tourniquet is a wide band of cloth
or a belt that is placed around an extremity and tight-
ened (usually using a windlass) until the blood flow is
cut off. The blood supply must be compressed against
a long bone (the upper arm or upper leg) since vessels
between the double bones in the lower arm and lower
leg will continue to bleed despite a tourniquet. The
amount of pressure necessary typically causes addi-
tional vascular and nerve trauma that is permanent. A
tourniquet should only be used as a last resort to
save a life at the expense of sacrificing a limb.
Immobilize the injured area.
Using splints and dressings to immobilize an injured
area helps protect from further injury and maintain
clots that have begun to form. Even if an injury to a
bone or joint is not suspected, immobilization will
promote clotting and help healing begin.
Dress the wound, and strive to prevent infection.
Use sterile (or at least clean) dressings as much as
possible. Penetrating injuries may allow anaerobic
(air-hating) bacteria to get deep into the tissue. This
is why penetrating wounds are typically irrigated with
sterile or antibiotic solutions in surgery. While this is
rarely practical outside of the hospital, it is important
to remember that smaller penetrating wounds (nail
holes in the foot and the like) should be encouraged
to bleed for a short period to help "wash out" foreign
material. Soaking an extremity in hydrogen peroxide
may help kill anaerobic bacteria as well. Do not apply
ointments or goo to penetrating wounds as these may
actually promote infection.
Emergency Tip
Some data indicate that pure granular sugar poured
into a penetrating wound can decrease bleeding, pro-
mote clotting, and discourage bacteria. You are not
likely to see it used in your local emergency depart-
ment, but it might be worth consideration if your
circumstances are dire.
Get medical attention as soon as possible.
Be Aware
It should be noted that tourniquets are rarely helpful�?
it is uncommon to have life-threatening
bleeding in an extremity that cannot be controlled by
the methods described above. The areas that cause
fatal bleeding (like the femoral arteries or intra-
abdominal bleeding) do not lend themselves to the
use of a tourniquet. Even most complete amputations
do not bleed all that much, and are controlled by
direct pressure. Arteries that are severed only part of
the way through tend to bleed more profusely than
those that are completely severed.
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