ANSWERS

1. What is the correct name for a nosebleed?
   Epistaxis.
2. What colour would you expect the mucous membranes of a patient having suffered severe haemorrhage to be?
   Very pale pink to white.
3. What is the name given to the type of shock caused by severe haemorrhage?
   Hypovolaemic shock.
4. An injured animal is presented to the surgery with fresh blood present on the face. Having cleaning the area, there is no evidence of a wound. How would you explain this?
   The blood may have been coughed up from the lungs or issued from wounds within the oesophagus.
5. Why must haemorrhage from the ear always be considered serious?
   This may be a sign of brain damage.
6. What type of haemorrhage is characterised by bright red blood spurting forcefully from a wound?
   Arterial haemorrhage.
7. What type of haemorrhage is characterised by dark red blood that issues from a wound in a steady stream?
   Venous haemorrhage.
8. What is another name for petechial bleeding?
   Capillary ooze.
9. What is meant by primary haemorrhage?
   Bleeding that occurs as a result of immediate damage to a blood vessel wall.
10. What is the difference between reactionary and secondary haemorrhage?
    Reactionary haemorrhage occurs 24-48 hours after an injury as a result of the displacement of a blood clot following a rise in blood pressure, whilst secondary haemorrhage occurs 3-10 days after an injury as a result of damage to a blood clot (or ligature) following bacterial invasion.
11. List 4 possible causes of internal haemorrhage.
    
    • Disease that causes erosion to the blood vessel walls (eg. neoplasia).
    • Clotting deficiency (eg. following Warfarin poisoning).
    • Damage to an internal organ.
    • Severe mucosal bruising.
12. Internal haemorrhage may be difficult to detect. What symptoms may be indicative of such a condition?
    
    • Coughing up blood.
    • Fresh blood present in the faeces.
    • Swelling of the tissues.
    • Distension of a body cavity.
    • Shock (see Q13).
13. List 10 signs of shock.
    
    • Pallid mucous membranes.
    • Prolonged capillary refill time.
    • Dry mucous membranes.
    • Hypothermia/cold extremities.
    • Rapid, feeble pulse.
    • Tachycardia.
    • Low urine output.
    • Increased ventilation.
    • Muscle weakness.
    • Depressed general demeanour.
14. State 3 tests that may be performed to confirm shock.
    
    • Measurement of blood pressure - shocked animals have a low mean arterial blood pressure.
    • Measurement of packed cell volume (PCV) - shocked animals have an elevated PCV.
    • Measurement of central venous pressure (CVP) - shocked animals have a depressed CVP.
      
      These tests are described in more detail in Part II - Laboratory Diagnostic Aids
15. Describe the 4 main natural factors that help to stop initial bleeding.
    
    • Retraction of the cut ends of the blood vessels - the elasticity of the walls enables contraction at the end of the vessel that reduces the size of the aperture through which the blood flows.
    • Lowered blood pressure - less blood reaches the affected vessel and there is less pressure forcing it through the aperture.
    • Back pressure - pressure in the damaged vessel becomes equal to that of the fluid surrounding the severed end thus preventing the escape of further blood.
    • Clotting mechanisms - clotting within and around the damaged end of the vessel acts as a plug that seals off the aperture thus preventing further blood loss.
16. List 5 first aid techniques used to arrest haemorrhage.
    
    • Application of direct digital pressure .
    • Use of artery forceps to occlude an artery and apply a ligature.
    • Application of a pressure pad or bandage.
    • The occlusion of an artery at a pressure point.
    • Application of a tourniquet.
17. Where are the 3 pressure points in the dog and cat?
    
    • The brachial artery - used to arrest arterial haemorrhage below the elbow.
    • The femoral artery - used to arrest arterial haemorrhage below the stifle.
    • The coccygeal artery - used to arrest haemorrhage from the tail.
18. State 3 disadvantages of the application of direct digital pressure.
    
    • A foreign body within the wound may be pushed deeper inside.
    • If a bone is fractured, fracture fragments may be displaced.
    • Unsuitable for the long-term control of haemorrhage.
19. What is the name of the type of dressing used to prevent overlying pressure bandages from applying direct pressure to a protected area (such as where an embedded, protruding foreign body is present)?
    A ring pad dressing.
20. What is the maximum time that a tourniquet should be left in place?
    15 Minutes.