A 40 year female who underwent subtotal thyroidectomy developed respiratory distress 8 hours after the operation. The skin sutures were opened in the ward but the distress persisted. What is next likely step in management?: (A) Immediately shift the patient to operation theatre, (B) Patient should be intubated in the ward, (C) External pressure should be applied over the neck to stop bleeding, (D) Open the layers of the wound in the ward.
Answer is D. The most important cause of respiratory distress is tension hematoma.
Generally the distress is relieved by opening the skin suture.
On rare occasions, it may be necessary to open the layers of the wound, not simply
the skin closure, to relieve tension before taking the patient to theatre to evacuate the hematoma & secure the bleeding vessel.