A patient in the recovery room develops stridor and paradoxical chest movement 25 minutes after extubation following thyroidectomy. The MOST likely cause and IMMEDIATE management is:
- A Laryngospasm — apply CPAP/jaw thrust; give succinylcholine 0.1 mg/kg IV if persistent
- B Bilateral recurrent laryngeal nerve injury — emergent re-intubation or surgical tracheostomy
- C Haematoma compressing the trachea — immediate bedside wound opening and clot evacuation ✓
- D Hypocalcaemia from parathyroid removal — IV calcium gluconate 10 mL of 10%
Correct answer: C. Haematoma compressing the trachea — immediate bedside wound opening and clot evacuation
Explanation
Post-thyroidectomy stridor occurring 20–30 minutes post-extubation in the recovery room is caused by expanding haematoma compressing the trachea — a surgical emergency. The wound must be immediately opened at the bedside (even in the PACU) to evacuate the haematoma and relieve tracheal compression, as the patient can asphyxiate rapidly. After decompression, definitive airway management (re-intubation in optimal conditions) and return to theatre for haemostasis follow. Bilateral RLN injury causes aphonia/stridor at extubation, not delayed 25 minutes later.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.