Which of the following is the best initial action for a patient with a penetrating wound to the leg with active bleeding when other injuries are present?

• A. Apply a tourniquet immediately
• B. Control the bleeding and cover the wound with a sterile dressing
• C. Remove clothing to inspect wound
• D. Irrigate the wound with clean water

Answer: (B)

The most important idea here is that life-threatening external bleeding must be stopped as a first step. For a penetrating leg wound with active bleeding, the best initial action is to apply direct pressure with a sterile dressing and maintain that pressure until the bleeding slows or stops. If the dressing soaks through, add more sterile dressings and keep applying pressure rather than removing what’s already in place. This helps form a clot and reduces the risk of shock, which is the primary danger with significant blood loss.

Other actions aren’t the first move. Removing clothing to inspect the wound can waste valuable time and might worsen bleeding if you disrupt clots. Irrigating the wound is useful after bleeding is controlled to reduce contamination, not as the initial step. A tourniquet is reserved for situations where direct pressure cannot control the bleeding or in life-threatening limb hemorrhage where rapid control is necessary and other measures have failed. In this scenario, bleeding control with direct pressure and a sterile dressing is the best initial action, even when other injuries are present.