You got called urgently to the recovery to assess a gentleman who just underwent a left carotid endartectomy as the nurse noticed that he has an obvious swelling underneath his surgical incision.
What is your approach for managing this?
You got called urgently to the recovery to assess a gentleman who just underwent a left carotid endartectomy as the nurse noticed that he has an obvious swelling underneath his surgical incision.
What is your approach for managing this?
I will check if there is bleeding between the sutures , pulsatile hematoma
ask for anathesia team to secure the airway and possibility of intubation
Re-exploration to evacuate the hematoma if it’s increasing in size
I will check if there is bleeding between the sutures , pulsatile hematoma
ask for anathesia team to secure the airway and possibility of intubation
Re-exploration to evacuate the hematoma if it’s increasing in size
Abd
Check airway
Breathing
He bp
Drain if it is blocked
Arrange for urgent evacuation of heamatoma and rexploration
Based on the given Scenario, I will consider it hematoma until proved otherwise, I will review the wound for active bleeding or pulsatile swelling, check his vital signs if he is hypertensive or have difficulty in breathing. also I will check the drain if present.
I will consider the possibility to take the patient back to theatre to control any bleeding.
I will discuss with the anesthesia doctor if the patient is in need for intubation to secure his airway.
Immediate postoperative swelling is mostly due to hematoma formation.
We need first to assess and monitor for any compromise to respiration, oxygen saturation monitoring, call anaesthetist for possible need for intubation, inform the consultant for possible need for reexploration.
Assessment of respiration with possibility of urgent bedside intubation to secure airway and re exploration of wound.
CBC pt INR ACT prepare protamin sulphate fresh frozen plasma PRBCS
thank you for your response Dr Abdullah.
Can you elaborate on your assessment approach?
Do all haematomas need evacuation?
Are you going to intubate the patient? or do you need to call a friend(think like a team)
Case 2
Q1. Asessement will be conducted through ABCD most pt with large haematoma that affect airway has high BP and should be managed.
Small haematoma no need intervention but large haematoma that has comression symptom or fear from wound infecton should be evacuated.
( 1.2 – 3.9 %) developed a haematoma requiring re-exploration )
Q3. No. I woukd inform anesthesiologist to do that.