After thyroidectomy, on 2nd post operative day, an elderly lady developed dyspnoea with swelling of the neck. What is the next best step of management
Patient is having dyspnoea and swelling it can be due to respiratory obstruction or postop complications. Shift to OT immediately and investigate to find out the underlying cause Complications of Thyroidectomy Hemorrhage Due to slipping of ligature on the superior thyroid aery, bleeding from muscular aery Hematoma may cause airway compromise and must be evacuated immediately Hematoma may occur immediately or later on An immediate bleed occurs after or sholy before extubatiin when the patient lightens from anaesthesia and may begin to cough, causing a vessel to open Respiratory obstruction : Causes includes Tension hematoma Laryngeal edema (by anaesthetic intubation) : MC cause of respiratory obstruction Bilateral recurrent laryngeal nerve paralysis Recurrent laryngeal nerve paralysis May be unilateral or bilateral, transient or permanent Bilateral paralysis causes respiratory obstruction - Dyspnea, stridor Injury to other nerves External branches of superior laryngeal nerve Cervical sympathetic trunk - May cause Horner's syndrome Parathyroid insufficiency Due to removal of the parathyroid glands or infarction due to vascular injury Vascular injury is more impoant Cases usually present 2-5 days after operation with symptoms of Hypocalcemia (circumoral and fingeip numbness and tingling tetany, carpopedal spasm and laryngeal stridor) Treatment with oral calcium & vitamin D supplements. IV calcium gluconatr may be required in severe cases Thyroid insufficiency Thyrotoxicosis crisis. Occurs in the thyrotoxic patients has been inadequately prepared for thyroidectomy Ref: schwaz's principle of surgery 10th edition Pgno : 1373
Shift to OT immediately
Release 2-3 stitches over the skin
Prepare for intubation and mechanical ventillation
Wait and watch
Endocrinology and breast