Breathing difficulty and desaturation after thyroidectomy must be treated as a compressive neck hematoma until proven otherwise, because it can compress the trachea. The dressing hides the wound, so the immediate step is to remove it and examine the wound, then open it to release the tension if a hematoma is present.

• Reassuring her, giving fluids, or looking for DVT/PE wastes time while the airway is at risk.