In a 54-year-old man with a gunshot wound to the leg, with entrance wound medial leg, exit wound opposite side, and numbness in the foot, the immediate action should be to

• A. Control the bleeding and cover the wound with a sterile dressing
• B. Apply a tourniquet immediately
• C. Explore the wound on scene
• D. Administer antibiotics immediately

Answer: (A)

The most urgent thing to do is stop life-threatening bleeding. In penetrating trauma to a limb, controlling hemorrhage is the top priority because rapid blood loss can fatally compromise the patient before other injuries are addressed. The immediate action is to apply firm direct pressure with a sterile dressing to the entrance and exit wounds, and to maintain that pressure rather than quickly removing dressings or probing the wound. If the bleeding cannot be controlled with direct pressure alone, then escalate to a tourniquet placed high on the limb and tighten it until bleeding slows or stops, but only after you’ve attempted direct pressure first.

The numbness in the foot signals possible nerve injury or compromised blood flow, so you should assess distal neurovascular status—check for pulses, movement, and sensation—while you manage bleeding and transport. After bleeding control, you can immobilize the leg with a splint if needed and ensure rapid transport. Antibiotics on scene are not the immediate action, and exploring the wound on scene is not appropriate.