護理師照護一位甲狀腺切除術後 4 小時的病人，發現病人出現喉部喘鳴（laryngeal stridor）。何者為優先處置？
A nurse is caring for a client who is 4 hours post-thyroidectomy. The nurse notes the client has developed laryngeal stridor. Which action is the priority?
- AIncrease the flow rate of the intravenous fluids增加靜脈輸液的流速
- BPrepare for immediate tracheostomy or airway support✓ 正解準備立即進行氣管切開術或提供呼吸道支持
- CPerform an assessment of the surgical site for hematoma評估手術部位是否有血腫
- DAdminister an IV bolus of calcium gluconate靜脈注射葡萄糖酸鈉推注劑
喉部喘鳴（laryngeal stridor）是呼吸道阻塞的危急徵兆，常見於甲狀腺切除術後，可能由喉頭水腫、喉返神經損傷引起的聲帶麻痺，或術後血腫壓迫氣管所致。根據 ABC 原則（氣道、呼吸、循環），氣道通暢是首要任務。當病人出現喘鳴，顯示呼吸道空間已嚴重受限，必須立即準備氣管切開術（tracheostomy）或人工氣道設備以防窒息。此狀況屬於臨床高危險情境，護理師需同時通知外科醫師並準備緊急插管或氣切包。
Laryngeal stridor is a critical sign of airway obstruction, often caused by laryngeal edema, vocal cord paralysis, or hematoma compression post-thyroidectomy. According to ABC principles, securing the airway is the highest priority. Therefore, the nurse must prepare for immediate tracheostomy or airway support to prevent asphyxiation.
在美國臨床實務中，呼吸道阻塞屬於 Rapid Response Team (RRT) 啟動指標。台灣護理師需特別注意美國醫院對於氣道維護的授權範圍，緊急狀況下護理師應立即呼叫急救小組 (Code Blue 或 Rapid Response)，而非僅僅等待醫師到場。