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Wave 2: Module 4: Carotid, Vascular access and Venous – Week 2 – Case 2
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?
hematoma until proved otherwise
first i check the airway quickly, if he is in distress i call anesthesia and open the wound immediately to release pressure
if airway is ok i take him back urgently to theatre to evacuate hematoma and stop bleeding
mostly post surgical hematoma, urgent scan then rapid surgical evacuation
A:
The most likely scenario is neck hematoma
Management plan
ABCDE
If the patient has stridor or trachea deviation so urgent bed side decompression then take the ptn to the OR for definitive exploration evacuation and control of bleeders and drain
Post-CEA Neck Swelling
│
▼
Assess airway (ABC) + vital signs
│
┌─────┴ ——————─────┐
▼ ▼
Airway stable Airway compromised
(no stridor, (stridor, distress,
good O₂ sat ) rapidly expanding)
│ │
Prepare OR Open wound at bedside
Urgent return Evacuate hematoma to
to theatre secure airway → OR
│
▼
Re-open incision + evacuate hematoma
Secure bleeding point ± drain
ICU monitoring post-operative