A 42-year-old woman is evaluated in the post-anesthesia care unit 3 hours after a total thyroidectomy for a large multinodular goiter. The nurse urgently calls for evaluation because the patient is agitated and reports increasing difficulty breathing. Her blood pressure is 162/94 mm Hg, pulse is 118/min, and respirations are 28/min. Pulse oximetry shows an oxygen saturation of 88% on room air. Physical examination reveals audible inspiratory stridor. The anterior neck appears significantly swollen, tense, and ecchymotic beneath the surgical dressing. Arrange the following steps in the most appropriate chronological order for the immediate management of this patient's condition.
- 1Remove the surgical dressing and open the cervical incision at the bedside
- 2Manually evacuate the accumulated blood clots to decompress the trachea
- 3Establish a secure airway via endotracheal intubation
- 4Transport the patient to the operating room for definitive surgical hemostasis
Answer
The correct sequence is to first open the cervical incision at the bedside, then manually evacuate the blood clots, followed by establishing a secure airway via endotracheal intubation, and finally transporting the patient to the operating room for definitive surgical hemostasis.
The correct sequence prioritizes immediate bedside decompression of the expanding neck hematoma. Opening the wound and evacuating the clot relieves external tracheal compression, which is absolutely necessary before attempting intubation or transferring the patient to the operating room.
Step-by-Step Solution
Key Concept
Management of Postoperative Neck Hematoma