A patient in the PACU after thyroidectomy is agitated, hoarse, with rising ETCO2 and declining SpO2. Examination reveals a tense neck haematoma. What is the IMMEDIATE management priority before anything else?
- A Administer IV dexamethasone to reduce oedema and call the surgeon
- B Perform emergency tracheostomy at the bedside
- C Attempt fibre-optic intubation and transfer to OR immediately
- D Open the wound at the bedside to release haematoma and relieve tracheal compression, while calling for the surgeon ✓
Explanation
Post-thyroidectomy neck haematoma causes rapidly progressive airway compression through tracheal displacement and laryngeal oedema — it can cause total airway obstruction within minutes. The immediate lifesaving manoeuvre is to open the wound at the bedside and evacuate the haematoma to relieve tracheal compression; this can be done with suture removal or by opening skin clips. This buys time for definitive airway management (intubation) and surgical haemostasis in the operating room. Waiting for theatre preparation while the airway obstructs is dangerous. Steroids and fibre-optic scope have no role in the acute obstructing haematoma.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.