A 60yo pt recovering from a surgery for toxic goiter is found to be hypotensive, cyanosed in the
the RR. Exam: tense neck. There is blood oozing from the drain. What is the most likely dx?
a. Thyroid storm
b. Reactionary hemorrhage
c. Secondary hemorrhage
d. Primary hemorrhage
e. Tracheomalacia
answer B 
(1) During the first 48 hours (reactionary haemorrhage) because a clot 
in a vessel has been displaced,  or a ligature has slipped.  Or,  (2)   8
 to 14  days later (secondary  haemorrhage)  when the wound has become 
infected and eroded a  vessel,  usually quite  a  small one,  sometimes a
 larger one.
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