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Discussion

Urgent question: thyroidectomy

hi. Im doing a casestudy for my assignment involving potential post-op complications for thyroidectomy. If a patient is having a post-op bleeding, I would intentionally open the surgical incision, ensure that they are in 30-45degree position and administer 6L of oxygen via hudson's mask ?

I just want to confirm ...

Thanks

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    I'm not sure what your book says to do, but for bleeding I would apply pressure w/ a sterile gauze (obviously if it's an area I can apply pressure to; that doesn't work so well if they're bleeding into their belly). Per ACLS protocols, supplemental oxygen is indicated for sats

    As a nurse I would not open an incision; as far as I know, that's not in an RN's scope. Besides, you could open up more vessels than the ones that are already bleeding

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    I don't think opening the neck incision is a nursing intervention. If you are with the patient call for help.

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    • Admin

    I would never open an incision without a) a surgeon in the immediate area who has given express direction to do so; and b) a surgical setup to deal with any bleeding encountered. So, basically, the only place to safely open an incision is in the OR, or in absolute life-threatening situations where the brief transport to the OR means loss of life, an equipped ICU or ER. Have I personally opened an incision? No, but I have watched another person in the OR do it- the surgeon expressly told the person to get the sutures out of the sternal incision while he and the PA were scrubbing in to figure out why the patient was bleeding immediately post heart surgery, and we already had the instrument table set up. And to be quite honest, that person was most likely outside of his/her scope of practice.

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    I agree. The best thing to do is to try to control the bleeding. Also making sure the airway is as clear as you can make it hence the semi Fowlers position and supplemental oxygen if needed. Also be careful with aspiration when bleeding after a thyroidectomy could go hand in hand with the semi Fowlers positions. Do not leave the patient!

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    Are you from another country? Serious question and I am not judging. I ask because I am almost positive that opening a surgical wound (not just stitch/staple removal once healed, but straight opening the wound) is not in an RNs scope of practice in the US. I could be wrong, but Im pretty sure I'm not. I especially know that the bleeding surgical wound should not be done in the room unless it is an absolute emergency and there is no time to move the patient. Lastly, I am pretty positive that even if it was in RN scope of practice, that an order would be needed and/or a surgeon present. All around, opening a surgical wound when a patient is bleeding in their room just sound like a bad idea.

    When thinking of an intervention, you should ask yourself "Why am I doing this?" So to ask you, what is the rationale for you wanting to open the surgical wound as a nurse who cannot do anything else inside the wound once open? And, what therapeutic benefit does the patient receive by you opening the surgical wound while they are bleeding?

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