Test question: Neck surgery and stridor

[abbyann]

Hi everyone,

We had an exam today, and one question is really bothering me. It was on care of the surgical patient. The question asks what you do first if a patient who has just had neck surgery starts exhibiting stridor. I answered that you would reposition him to clear the airway. But my friends and I were discussing it later, and they were convinced that you would start O2 first; that you can't reposition him because of his neck surgery. But you have to reposition him, don't you? O2 won't do any good if the airway is blocked.

Any ideas?

[CrufflerJJ, BSN, RN, EMT-P]

Hi everyone,

We had an exam today, and one question is really bothering me. It was on care of the surgical patient. The question asks what you do first if a patient who has just had neck surgery starts exhibiting stridor. I answered that you would reposition him to clear the airway. But my friends and I were discussing it later, and they were convinced that you would start O2 first; that you can't reposition him because of his neck surgery. But you have to reposition him, don't you? O2 won't do any good if the airway is blocked.

Any ideas?

Was there an option along the lines of "call the doc/surgeon"?

If you think about stridor - what's happening in the (upper) airway to create it, applying O2 won't address the airway constriction, as you said. If one of the answers wasn't to call the doc, then I guess O2 wouldn't hurt. If the airway is swelling, repositioning would probably not help much either (the stridor isn't likely due to improper positioning).

If I was faced with this patient, I'd want a doc on hand NOW in case a trach was needed to protect the airway.

[abbyann]

I don't think call the doctor was an option. I probably would have chosen it, if it was.

That's one of those questions my class will be talking about for a long time.

Thanks for your help. I will post tomorrow, if I can get the righ answer from my instructor.

[manxx, ASN, BSN, MSN, LPN, RN, APRN]

kkkkk

[ElliShay]

I think your answer (and your reasoning) is correct. All the O2 in the world will do no good if the airway isn't open...

[abbyann]

That's what I thought. We got our grades today; we'll be able to discuss the answers next week.

Thanks!

[ElliShay]

You could open the airway via the jaw thrust maneuver... anyway, let us know what you find out!

[abbyann]

I will. We have projects due Monday, so she won't be going over it until Tuesday. I may not find out for sure if it wasn't missed by more than 50% of the class.

Thanks!

[XB9S, BSN, MSN, EdD, RN, APN]

Post neck surgery a stridor is going to be caused by post-operative swelling or possibly bleeding. A stridor would indicate a partial rather than a complete airway obstruction so O2 would help and with any emergency situation high flow O2 is indicated. The standard airway techniques are going to be of limited use because the cause of the stridor is not due to poor airway positioning, however sitting the patient up and extending the neck as much as possible may help until a definitive solution can be found, this patient is going to need the attention of the surgeon to release the pressure. We used to keep clip removers at the bedside so in the case of stridor with associated respiratory distress we would remove the clips to release the pressure whilst another nurse fast bleeped the surgeon.

[abbyann]

I think they don't expect us to know that much. We're still in our first term. I think she wanted to see if we knew the basics, like what it is. And a lot of the class didn't.

Thanks!

[abbyann]

I got it right!!! :)