During total thyroidectomy, a patient develops acute neck swelling, stridor and respiratory distress within 30 minutes of extubation in the operating room. The wound is tense and bulging. What is the single most important immediate step in management?

• A Urgent CT scan of the neck to confirm hematoma
• B Intravenous tranexamic acid infusion
• C Reintubation with rapid sequence induction
• D Immediate bedside wound opening and evacuation of hematoma ✓

Explanation

Post-thyroidectomy hematoma causing airway compromise is a surgical emergency. The most critical step is immediate bedside wound opening with release of skin and subcuticular sutures to evacuate the expanding hematoma, even before formal return to operating room. Delaying for imaging or attempting difficult intubation in the setting of airway compression can be fatal. Once the pressure is relieved, the patient can be taken back for formal evacuation and hemostasis. Bailey and Love emphasizes that this decision must not be deferred.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

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Written and medically reviewed by the StethoPrep medical team.