Hoarseness vs hypocalcemia? Which will kill you first?

enuf_already · Jul 12, 2015

Hoorificeness could be a normal result of intubation and not necessarily a symptom of airway occlusion.

I woke up hoorifice after abdominal surgery all due to intubation.

LadyFree28, BSN, LPN, RN · Jul 12, 2015

Hoorificeness could be a normal result of intubation and not necessarily a symptom of airway occlusion.
I woke up hoorifice after abdominal surgery all due to intubation.

So did I.

Hypocalcemia is an issue that needs to be addressed ASAP; hunk about what complications occur when hypocalcemia is not treated...

enuf_already · Jul 12, 2015

What symptoms would you get with airway occlusion and what would you see with calcium abnormalities?

enuf_already · Jul 12, 2015

[Complications in thyroid surgery: symptomatic post-operative hypoparathyroidism incidence, surgical technique, and treatment]. - PubMed - NCBI

Hoorificeness itself doesn't kill anyone. Now if you are hoorifice because you have throat cancer, an obstruction, or something else going on, it could eventually kill you but I don't know that hoorificeness could be listed as an actual cause of death.

If you said hoorificeness, you lose.

There are many good articles such as the abstract I linked to that discuss hypocalcemia after thyroidectomy.

annie.rn · Jul 12, 2015

Hoorificeness should be investigated because as previous posters have mentioned, it definitely doesn't automatically mean airway obstruction. It can be a common complication of thyroidectomy as the laryngeal nerves are often irritated as the thyroid gland and neck tissues are manipulated. It usually goes away after a month or so on it's own.

I would do a quick investigation, however, to make sure the airway is not compromised:

-Is there audible stridor?

-Wheezing in the upper airways? (auscultate)

-Does the patient c/o difficulty breathing?

-Visible swelling of the neck or the incision?

-Cyanosis?

-RR

-Pulse ox.

-Difficulty swallowing? Not just a little sore throat (common after intubation) but difficulty swallowing to the point of being unable to handle secretions.

Hypocalcemia is expected and I would want to treat it ASAP but I wouldn't be overly stressed unless the pt. was symptomatic.

To answer your question, I would investigate both and depending on what I found after my investigation, I would THEN decide which needs the most imminent treatment.

Edited b/c I posted before finished, as always. Darn i-phone :-)

LM NY · Jul 13, 2015

Ok then if you had the options stridor or tingling of the mouth then which would concern the nurse most? It would be stridor, right?

NurseGirl525, ASN, RN · Jul 13, 2015

Hoorificeness can mean a lot of different things. Whereas, the hypocalceima is confirmed and will end up resulting in muscle weakness or worse. This puts the patient at risk for a lot of things including injury and fall. Look at what is going on with the patient at this minute.

more than likely the hoorificeness is from intubation. Happens all the time. Look their vitals. That is going to indicate the respiratory distress. I think you are reading too much into hoorificeness. It's not the what ifs here. It's what is going on right now. Right now, your patient has hypocalcemia. Take care of that so your patient doesn't get worse.

If their airway in danger at that moment, then yes, your airway is first. Maslow says physiologic needs are at the bottom of the pyramid. That includes calcium.

annie.rn · Jul 13, 2015

Ok then if you had the options stridor or tingling of the mouth then which would concern the nurse most? It would be stridor, right?

Yes, airway always comes first.

However, in reality, you can treat two things simultaneously so I'd get a coworker to get the calcium replacement going while I maintained the airway.

vanilla bean · Jul 13, 2015

Hoorificeness and stridor are not the same thing (you changed the terminology used between your first and second posts). Stridor = airway emergency. Think airway swelling or obstruction to the point of near closure, as in severe edema, advanced epiglottitis or a foreign body obstruction, etc. Hoorificeness, as others have pointed out, can have a variety of causes, like from having had an irritating ETT in place or even from a persistent cough from a cold (or from screaming your head off at a concert all night! Just me?). Hoorificeness can also be a precursor to an airway emergency, so those patients need to be closely monitored. Stridor *is* an indication of an airway emergency. I'm assuming we're talking about an adult here because it's related to a thyroidectomy. In kids, could be a whole different ballgame.

nurseprnRN, BSN, RN · Jul 13, 2015

Hoorificeness is a common and expected side effect of thyroid surgery. You do a quick (and ongoing) airway assessment by asking your patient to speak to you-- only hoorifice, not a problem. Frowning, looking like he's struggling to get air in, stridorous, not good.

Hypocalcemia, also common, but also more dangerous. Chvostek's, anyone?

blackribbon · Jul 14, 2015

This sounds like a NCLEX scenerio that I kind of remember...first, circulation and airway/breathing are always the priority function...so do a respiratory assessment first ... if it is just a sore throat or expected levels of edema then move on...then address the neurological issues related to getting the parathyroid glands accidentally during the surgery. Your priority activity is always the one that will kill you first...low calcium will take longer than a compromised airway...however it will harm faster than just normal slight edema from the endotracheal tube (which will resolve on its own). The NCLEX version of this won't be so cut and dried...so understand what you would do and why so that when you get to the NCLEX you will know what piece of equipment to be grabbing or what is your second activity AFTER you have done the priority function...

Excessive swallowing might be a priority too because it may indicate an active post surgical hemorrhage...