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Summary of the Day

Anticoagulants

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Question of the Day

Ten hours after total thyroidectomy, a patient is found to be obtunded and cyanotic. The patient's SpO2 is 70%. What is the MOST likely etiology of this clinical deterioration?

Question of the Day
Ten hours after total thyroidectomy, a patient is found to be obtunded and cyanotic. The patient's SpO2 is 70%. What is the MOST likely etiology of this clinical deterioration?
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Explanation

A compressive hematoma is the most common cause of airway obstruction 24 hours after thyroidectomy. Acute hypocalcemia typically manifests 24 to 48 hours postoperatively with laryngeal stridor and airway obstruction. Prior to stridor, the patient may complain of a tingling sensation in the lips and fingers. If recurrent laryngeal nerve damage occurs, it is more likely to be unilateral and present with hoarseness. If both recurrent laryngeal nerves were severed, severe airway obstruction occurs immediately. Hematoma is the most common cause of airway obstruction within 24 hours of a thyroidectomy. The definitive treatment of a hematoma is opening the surgical incision to evacuate the hematoma and relieve the airway obstruction.

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