4. Abnormal findings — the necessity chain
Finding → severity → comparison → risk → intervention → notification (provider + representative) → orders → response → reassessment.
Model abnormal 1 |
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Post-thyroidectomy neck hematoma — airway emergency: the resident with new, increasing neck swelling and fullness, a feeling of pressure or difficulty breathing, and a change in voice — concerning for an expanding hematoma compressing the airway. Emergency help/EMS activated per policy, the surgeon and provider notified immediately, the resident positioned and the airway supported, and preparation for emergency wound opening/airway management per protocol; the responsible party notified. Skilled recognition required, as a post-thyroidectomy neck hematoma is a life-threatening airway emergency. |
Model abnormal 2 |
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Post-thyroidectomy hypocalcemia: new perioral numbness and tingling of the fingers with muscle twitching (and a positive Chvostek/Trousseau where assessed) — concerning for hypocalcemia from parathyroid disruption. The provider notified, calcium/labs obtained per order, calcium replacement given per order, and the resident monitored for tetany and, critically, laryngospasm; the responsible party notified. Will reassess symptoms and calcium; supports the Section I update. Skilled recognition and management required, as severe hypocalcemia can cause laryngospasm and seizures. |