Control

• Pressure between finger and thumb, against a firm base with a finger or swab, or gentle compression using a non-crushing clamp stops bleeding. Sometimes a confined region can be packed with one or more swabs to compress one or several bleeding vessels. If bleeding is severe, pressure should not be relaxed for 5 min, timed by the clock. Arterial bleeding that is difficult to reach can often be controlled by compressing the proximal supplying vessel.

• Ligature control of a divided vessel must be preceded by capture with a haemostatic forceps.

• Sutures can be used to constrict a vessel that is difficult to isolate. They are also useful to appose oozing surfaces after completing all other appropriate measures.

• Diathermy current can also be applied once a small vessel is captured with a forceps.

• Coagulating agents may be applied over areas of capillary oozing. Gelatine foam, absorbable gauze and powdered collagen are usually effective, or a small piece of excised, crushed muscle can be sewn over the area.

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