A 42-year-old woman is evaluated in the post-anesthesia care unit 4 hours after undergoing a total thyroidectomy for a toxic multinodular goiter. The nursing staff urgently requests assistance because the patient is highly agitated, reporting severe neck pressure, and having significant difficulty breathing. Vital signs show a temperature of 37.1°C, heart rate of 118/min, blood pressure of 152/94 mm Hg, respiratory rate of 28/min, and oxygen saturation of 88% on room air. Physical examination reveals audible inspiratory stridor. The anterior neck incision is intact, but the surrounding tissue is markedly swollen, tense, and ecchymotic. Arrange the following management steps in the correct chronological order.
- 1Remove the incision closures and open the deep cervical fascia at the bedside
- 2Perform endotracheal intubation to secure the airway
- 3Transport the patient to the operating room
- 4Perform formal wound exploration to achieve definitive hemostasis
Answer
The correct sequence is to first decompress the wound at the bedside, followed by endotracheal intubation, transporting the patient to the operating room, and finally performing formal wound exploration.
The patient is experiencing an expanding neck hematoma following a thyroidectomy, leading to impending airway obstruction (evidenced by stridor and hypoxia). The first and most critical step is to immediately open the wound (including cutting the sutures and opening the deep cervical fascia) at the bedside to relieve the pressure on the trachea. Once the tension is released, the anatomy is decompressed, allowing for safer endotracheal intubation to secure the airway. After the patient is stabilized and the airway is secure, they should be transported to the operating room for formal surgical exploration, hematoma evacuation, and definitive hemostasis.
Step-by-Step Solution
Key Concept
Acute Management of Postoperative Expanding Neck Hematoma
Estimated Time:1m 30s