During care for a casualty with shrapnel protruding from a leg wound after an explosion, what is the recommended action?

• A. Apply bulky dressing around the protruding fragment and secure with a bandage.
• B. Remove the fragment to stop the bleeding.
• C. Cover the wound loosely with a dry cloth.
• D. Push the fragment deeper to stop bleeding.

Answer: (A)

Stabilizing an injury with a protruding fragment centers on protecting the wound while preventing further damage. The fragment is already acting as a stopper for bleeding in some cases and helps seal the tract, so removing it or pushing it deeper can unleash life-threatening bleeding and cause more tissue injury. The best approach is to build a protective, stable dressing around the fragment. By applying a bulky dressing around the protruding piece and securing it with a bandage, you create gentle compression around the wound, absorb blood, and immobilize the fragment to prevent movement. This controls bleeding and reduces contamination risk without disturbing the fragment.

Covering the wound loosely with a dry cloth would not provide adequate stabilization or compression and could allow contamination. Attempting to remove the fragment or push it deeper would worsen injury and bleeding.