一位 40 歲女性甲狀腺全切除術後正接受密切監測。護理師接獲呼救進入病房，發現個案緊抓喉嚨、呼吸困難，並可聽見明顯的吸氣性喘鳴音（stridor）；頸部無菌敷料因迅速擴大的血腫而緊繃膨起。為了降低即將發生氣道阻塞的風險，護理師應預期到哪項併發症？必須立即採取什麼措施？
A 40-year-old female client is being closely monitored after a total thyroidectomy. The nurse responds to a commotion and finds the client clutching her throat, struggling to breathe, with audible inspiratory stridor. The sterile dressing over the neck appears taut from a rapidly expanding hematoma. To reduce the risk of imminent airway obstruction, which complication should the nurse anticipate, and what action must be taken immediately?
- AAnxiety-related hyperventilation; the nurse should provide calm reassurance and coached breathing.焦慮引起的過度換氣；護理師應提供冷靜的安慰並指導呼吸
- BTracheal deviation from a tension pneumothorax; the nurse should prepare a chest tube for pleural insertion.張力性氣胸引起的氣管偏移；護理師應準備胸腔引流管進行胸膜置入
- CMedication-induced pulmonary edema; the nurse should administer IV furosemide to reduce fluid.藥物引起的肺水腫；護理師應給予靜脈注射 furosemide 以減少體液
- DAirway obstruction caused by an expanding neck hematoma compressing the trachea; the nurse should immediately call a rapid response/code, and prepare a tracheostomy and suture-removal set at the bedside.✓ 正解擴大的頸部血腫壓迫氣管所致的气道阻塞；護理師應立即呼叫快速反應小組/急救團隊，並在床邊準備氣管切開術包與縫線拆除組
甲狀腺切除術後最危及生命的併發症之一是「擴大中的頸部血腫壓迫氣管」造成急性氣道阻塞。頸部空間有限，若手術部位的血管結紮鬆脫，血液會於皮下迅速積聚形成緊繃的血腫塊；血腫無法向外擴張，會由前方壓迫柔軟的氣管使其變窄，吸氣時氣流通過狹窄處便產生高頻的喘鳴音（stridor），這是氣道緊急的危險訊號。護理師的優先處置：(1) 立即啟動 rapid response 或 code；(2) 將病人擺成 high-Fowler 姿勢；(3) 床邊備妥 tracheostomy set 與 suture-removal set——必要時需在床邊拆除頸部縫線以釋放血腫壓力，恢復氣道通暢。其他選項：B 氣胸不會引起頸部血腫；B 肺水腫呈濕囉音與粉紅泡沫痰，並無頸部腫塊；D 將氣道阻塞誤判為焦慮過度換氣會延誤救治。
An expanding neck hematoma after thyroidectomy can compress the trachea, causing life-threatening airway obstruction evidenced by inspiratory stridor and a taut dressing. The nurse must immediately activate a rapid response and prepare to remove sutures at the bedside to relieve pressure, rather than misinterpreting the signs as anxiety or other conditions.
世界級外科學與耳鼻喉特有的送命題。「Thyroid Surgery (甲狀腺手術) 床頭一定要備 Trach kit (氣切包) 或 Suture remove kit (拆線包)，聽到 Stridor (喘鳴) 立刻拆線防窒息」。這是所有病房無可逾越的防線守則。