DECIDEJunctional = groin, axilla, neck base, perineum — no bone to compress against. · “Compressible with effort” — packing works here.
STEPS · ◆ KEY STEP — LOGGED WITH ITS TIME
TECHNIQUE — STEP BY STEP
Direct manual pressure first, anchored against an adjacent bony structure where possible.
Pack INTO the cavity, layer by layer, until nothing more will go in.
Hold uninterrupted pressure for at least 3 minutes. Do not release to check.◆ PRESSURE HOLD STARTED
Soaked through after the full hold → remove, repack fresh, hold again.
iTClamp: head and neck wounds with apposable edges only. Never groin, axilla or perineum. Keep it ≥1 cm from the eye or eyelid; on the neck, watch for airway compromise.
EQUIPMENT
Gloves, hemostatic gauze (or plain Kerlix), and enough people to hold pressure.
IN THE KIT — 5 ITEMS · TRAUMA CART · DRAWER 4 · HEMORRHAGE CONTROL 2
Hemostatic gauze — Combat Gauze / Celox, if stocked ×2
Plain roller gauze / Kerlix — if hemostatic gauze is not stocked ×4
Pressure dressing×1
Permanent marker — time of application ×1
Trauma shears×1
ALSO NEEDED — NOT IN THE KIT
A dedicated junctional tourniquet (SAM Junctional, CRoC, JETT) if your department stocks one — most rural EDs do not.
DRAFT — not yet assembled or signed off. Pack with two hands and your full body weight. Stock enough gauze for packing.
FIGURE
PACK DIRECTLY INTO THE CAVITY, NOT OVER THE SURFACE
HOLD PRESSURE ≥3 MIN — DO NOT RELEASE TO CHECK.
2 FAILED PACKING ATTEMPTS → ESCALATE
PITFALLS & PEARLS
The “wicking effect” — packing that absorbs without tamponading.
Repeatedly checking/disturbing a packed wound before the hold time is complete.