Internal bleeding where the torso meets the extremities ("junctional sites" such as the axilla or groin) cannot be controlled with a tourniquet; however there is an FDA approved device known as an Abdominal Aortic and Junctional Tourniquet (AAJT) designed for proximal aortic control, although very few studies examining its use have been published.Croushorn J. Abdominal Aortic and Junctional Tourniquet controls hemor-rhage from a gunshot wound of the left groin.JSpecOperMed.2014;14(2):6–8.Croushorn J, Thomas G, McCord SR. Abdominal aortic tourniquet controlsjunctional hemorrhage from a gunshot wound of the axilla.J Spec Oper Med.2013;13(3):1–4.Rall JM, Ross JD, Clemens MS, Cox JM, Buckley TA, Morrison JJ. Hemo-dynamic effects of the Abdominal Aortic and Junctional Tourniquet in ahemorrhagic swine model.JSurgRes. 2017;212:159–166.Kheirabadi BS, Terrazas IB, Miranda N, Voelker AN, Grimm R, Kragh JF Jr,Dubick MA. Physiological Consequences of Abdominal Aortic and Junc-tional Tourniquet (AAJT) application to control hemorrhage in a swinemodel.Shock (Augusta, Ga). 2016;46(3 Suppl 1):160–166.Taylor DM, Coleman M, Parker PJ. The evaluation of an abdominal aortictourniquet for the control of pelvic and lower limb hemorrhage.Mil Med.2013;178(11):1196–1201.Brannstrom A., Rocksen D., Hartman J., et al Abdominal aortic and junctional tourniquet release after 240 minutes is survivable and associated with small intestine and liver ischemia after porcine class II hemorrhage. J. Trauma Acute Care Surg.. 2018;85(4):717-724. For bleeding at junctional sites, a dressing with a blood clotting agent (hemostatic dressing) should be applied.
