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Post-Thyroidectomy Haematoma — FRCA Final MCQ

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HardAirway ManagementPost-Thyroidectomy HaematomaFRCA Final

Twenty minutes after total thyroidectomy, a 48-year-old woman develops severe respiratory distress in the post-anaesthesia care unit. She is awake and has stridor, a rapidly expanding tense neck wound and an oxygen saturation of 88% despite high-flow oxygen. Emergency surgical and anaesthetic help has been summoned. Which intervention should be performed immediately, without waiting for transfer to theatre?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Open the wound immediately at the current location and evacuate the haematoma using the SCOOP approach

The correct answer is A. Stridor, hypoxaemia and a rapidly expanding tense wound indicate airway compromise from a post-thyroidectomy haematoma. The wound must be opened immediately wherever the patient is located; transfer to theatre must not delay decompression. The SCOOP sequence is: expose the skin, cut sutures or clips, open the skin, open the superficial and deep muscle layers, and pack the wound. Intubation may still be required, but attempting it before decompression risks delay and failure because venous and laryngeal oedema may accompany external compression. Dexamethasone and nebulised adrenaline do not relieve the expanding collection. External pressure can worsen compression. After immediate decompression and oxygenation, the patient requires definitive surgical haemostasis in theatre.

Reference: Iliff HA et al. Management of haematoma after thyroid surgery: systematic review and multidisciplinary consensus guidelines from the Difficult Airway Society, BAETS and ENT-UK. Anaesthesia. 2022;77(1):82-95. https://pubmed.ncbi.nlm.nih.gov/34545943/