Simulation of Urgent Airway Management in a Postthyroidectomy Hematoma

Abstract

IntroductionAn expanding neck hematoma following thyroidectomy is a rare complication requiring urgent airway management and potential bedside evacuation before definitive surgical intervention. Due to its rare occurrence and life-threatening consequences, appropriate crisis resource management and a systematic approach are critical for patient safety.MethodsIn this simulation scenario using a high-fidelity mannequin, a 68-year-old male presented with an expanding cervical hematoma 2 hours after a total thyroidectomy. The target audience was junior residents (PGY 1, PGY 2) in otolaryngology–head and neck surgery. Residents were given a case stem to encourage active information gathering through history and physical examination. Setup and flow of the scenario were designed for residents to prioritize establishing an airway through bedside decompression of the hematoma prior to making operating room arrangements for definitive management. Standardized patients playing a ward nurse and patient family member added complexity to the case.ResultsSince 2012, the simulation has been used with a total of 96 residents as part of an annual boot camp. Surveys conducted after the boot camp verified the effectiveness of simulations in learning and, specifically, the usefulness of this scenario.DiscussionSimulation-based training is an effective learning modality for critical cases in health care disciplines involving emergency airway management. A well-developed simulation that closely resembles a real-life scenario is essential in creating a rich learning environment for trainees. Our scenario can be a valuable resource for other institutions implementing simulation-based training as part of their medical education.

Tata Laksana Perioperatif Pembedahan Tiroid : Sebuah Tinjauan Pustaka

“…3 Hematoma lebih sering dilaporkan setelah prosedur tiroidektomi total dibandingkan lobektomi, ekstubasi yang diikuti batuk atau muntah, riwayat penggunaan antitrombotik dan obat antiinflamasi nonsteroid (OAINS), tekanan darah pascaoperasi >150 mmHg, serta luasnya ruang anatomis yang kosong (deadspace) pada lokasi pembedahan tiroid. 3,30,31 Pembedahan perlu dilakukan secara hati-hati dengan teknik hemostasis yang adekuat dan dilakukan pengawasan obat yang dapat berkontribusi pada peningkatan kejadian perdarahan. 1,3 Hematoma dapat dikenali dengan menilai pembengkakan dan pembesaran lingkar leher di bawah lokasi insisi, meski pada awalnya gejala tersebut sulit dikenali.…”