When should you NOT use elevation in combination with direct pressure?

In the context of managing bleeding from an extremity, elevation is a technique intended to help reduce blood flow to the area and control hemorrhage. However, its application can vary depending on the nature of the injury.

When dealing with a possible extremity fracture, elevating the limb can be problematic. This is because elevation might worsen a potentially unstable fracture by causing additional pain or displacement of bone fragments, which could further damage surrounding tissues and blood vessels.

In contrast, for other situations like an amputation of an extremity, muscle lesions, or a pelvic fracture, elevation along with direct pressure can be beneficial in controlling bleeding. Elevating the entire limb in cases of amputation can help reduce blood flow and improve the effectiveness of direct pressure applied to the wound. Muscle lesions, which can also cause significant bleeding, benefit similarly from elevation. In the case of a pelvic fracture, although elevation is not commonly taught for pelvic issues, the concern primarily lies with the associated risks of internal bleeding and the need for immediate transport rather than the elevation technique itself.

Thus, in the case of a possible extremity fracture, the focus should remain on stabilizing the injury without causing undue movement or complications that could arise from elevation.