darkhorse
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A 32-year-old woman who has been a patient of yours since childhood underwent a total thyroidectomy for a 4-cm papillary adenocarcinoma. There were no intraoperative complications. During the surgery all 4 parathyroid glands were identified and preserved, and both recurrent laryngeal nerves were identified and were intact. You go to visit her in the recovery room after 1 hour, and while you are there, she develops progressive laryngeal stridor and becomes cyanotic. The most appropriate immediate management is
A. administration of epinephrine
B. endotracheal intubation with a laryngoscope
C. intravenous administration of calcium
D. nasotracheal suction
E. to open the entire wound
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| dr.wad
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..........
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| dr.wad
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B
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| bax
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B
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| darkhorse
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| dr.wad
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i guess the cause of resp distress is cmpressing hematoma and the definite management is openong the wound >> but the rapid and immediate intervention should be intubation to deliver sme oxygen to the patient........
please send the ans and explanation....
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| titly
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C. intravenous administration of calcium
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| dr penicillin
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B
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| darkhorse
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The correct answer is E. The thyroid gland is a highly vascular organ. Bleeding is one of the postoperative complications of thyroid surgery. Because of the limited nonexpansile space in the neck, a hematoma after thyroidectomy, can cause compressive symptoms on the trachea causing progressive stridor and cyanosis. Immediate evacuation of the hematoma by opening the wound is essential to regain airway control. Once a hematoma is evacuated and pressure symptoms relieved, the patient needs to be explored in the operating room for better hemostasis.
Epinephrine (choice A) is administered in a suspected hypersensitive reaction associated with tachycardia and hypotension. A postoperative patient can develop a hypersensitivity reaction from an allergic reaction to administered drugs. If epinephrine is administered in a bleeding episode, it might worsen the hematoma by increasing the blood pressure and causing more bleeding.
Endotracheal intubation with a laryngoscope (choice B) is ideal for better airway control, but in post thyroidectomy patients where a hematoma in the neck is causing pressure symptoms on the trachea, intubation is difficult without evacuating hematoma.
Intravenous administration of calcium (choice C) is indicated when hypocalcemia occurs due to hypoparathyroidism from inadvertent removal of the parathyroid glands in a thyroidectomy. When the parathyroid glands are identified and preserved, hypoparathyroidism is rare.
Nasotracheal suction (choice D) is helpful when cyanosis occurs due to thick mucous plugs in the respiratory tract. Stridor is usually due to laryngeal spasm rather than mucous plugging.
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| neuroblastoma
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thanks darkhorse.
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| darkhorse
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you are welcome neuroblastoma!
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