Six hours after total thyroidectomy, a patient develops rapidly increasing neck swelling, tachycardia, and stridor with rising airway pressure. The wound dressing is soaked with serosanguinous fluid. What is the immediate next step?
- A Immediate re-intubation in theatre followed by formal exploration
- B High-dose corticosteroids and observation
- C Open the skin incision at the bedside and evacuate the haematoma ✓
- D CT neck to define the collection before intervention
Correct answer: C. Open the skin incision at the bedside and evacuate the haematoma
Explanation
Post-thyroidectomy neck haematoma compresses the airway through both direct pressure and laryngeal oedema. Death occurs within minutes, so the clot must be released at the bedside by opening the incision and deep fascial layers before any transfer to theatre. Formal exploration, haemostasis, and intubation follow once the compression is relieved. Imaging wastes critical time, and waiting for theatre risks irreversible airway obstruction.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.