A 58-year-old woman develops acute respiratory distress, neck swelling, and stridor within 6 hours of total thyroidectomy. The wound is tense and erythematous. What is the single most important immediate step in management?
- A Open the wound at the bedside to evacuate the hematoma, then return to theatre for formal exploration ✓
- B Perform an urgent CT neck to confirm the hematoma before surgical intervention
- C Administer intravenous hydrocortisone and nebulized adrenaline, then observe in ICU
- D Perform an emergency cricothyroidotomy under local anesthesia
Correct answer: A. Open the wound at the bedside to evacuate the hematoma, then return to theatre for formal exploration
Explanation
Post-thyroidectomy hemorrhage causing expanding neck hematoma with airway compromise is a surgical emergency. The immediate step is to open the skin and deep fascial sutures at the bedside to decompress the hematoma, then transfer to theatre for formal hemostasis. Delaying for CT or attempting endotracheal intubation in the setting of airway compression from external hematoma can be fatal. Cricothyroidotomy is not the first step; wound opening is both diagnostic and therapeutic.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
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Written and medically reviewed by the StethoPrep medical team.