Circulation

Active bleeding is controlled by direct pressure at the site of injury. Do not clamp bleeding vessels, as additional damage to vascular or nervous structures may result. One should avoid placing intravenous access at a location where the IV fluid would flow toward the site of injury (for example, internal jugular or subclavian vein injury), and extravasate. Nasogastric tubes should be avoided during the initial resuscitation. Gagging and retching induced during NGT insertion could dislodge a clot and cause hemorrhage from a vascular injury.

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