Final answer:
The immediate critical intervention for a bleeding puncture wound is to apply direct pressure to control the bleeding and assist in the body's natural clotting process.
Step-by-step explanation:
During your secondary assessment of a patient who was injured while skiing and you find a puncture wound that is bleeding heavily, the critical intervention to perform immediately is direct pressure on the bleed. This step is crucial to control the bleeding and prevent further blood loss, which can significantly lower blood pressure and reduce perfusion to the brain and other vital organs. The body's natural response is to release substances that begin the process of blood clotting, and by applying direct pressure, you are aiding this physiological process and helping to stop the bleeding more efficiently, which is essential in managing acute traumatic injuries such as this.