Danger! Small wound

Wounds are always worrying, especially the large, gaping variety. Ironically, though, the smallest can be more serious – the critical factor is location.

A classic case was that of Toby, who has lived in the same luxurious stable for several years.One morning, his owners found blood outside the stable door, yet Toby greeted them as normal. They found a tiny cut below one eye, which was no longer bleeding, although it obviously had done so overnight. To this day, the cause of the injury remains a mystery.

I saw Toby as my first call of the day, when he appeared bright, although a little paler than one would expect, even from the visible blood he had lost. A close look revealed no other sources of bleeding, so the small wound was treated routinely. However, as Toby began to feel better, his blood pressure rose and he started to bleed profusely again through the same wound. It was then obvious that a major artery was involved and, indeed, by reaching a finger extremely deep into the wound,I could feel a tiny tear in the biggest blood vessel of the head, the carotid artery. The only way to stop it was to keep my finger there to stop the flow.

Toby’s owners calmly assisted me, despite their distress. After carefully packing the wound with sterile swabs and a big pressure bandage, we were able to control the bleeding sufficiently to move Toby to the clinic. After a blood transfusion and further surgical treatment, he recovered fully.

Afterwards, we realised that there was more blood under the rubber matting in the stable. It then became clear why Toby had been so pale.

So beware: investigate even the smallest wound with care!