A patient operated for thyroid surgery for a thyroid swelling, later in the evening developed difficulty in breathing. There was swelling in the neck. The immediate management would be

Haemorrhage is the most frequent life-threatening complication of thyroidectomy. Around 1 in 50 patients will develop a haematoma, and in almost all cases this will develop in the first 24 hours. If an aerial bleed occurs, the tension in the central compament pressure can rise until it exceeds venous pressure. Venous oedema of the larynx can then develop and cause airway obstruction leading to death. If a haematoma develops, clinical staff should know to remove skin sutures in order to release some pressure and seek senior advice immediately. Endotracheal intubation should be used to secure the airway while the haematoma is evacuated and the bleeding point controlled.Ref: Bailey and Love, page no: 815