Sudden respiratory distress with a bulging wound after thyroidectomy is a compressive neck hematoma. The sources say to open the wound immediately (remove the stitches) to relieve pressure on the trachea, then take the patient back to theatre for evacuation and hemostasis. A minimally stained dressing does not exclude a deep hematoma. Tracheostomy, cricothyroidotomy, or intubation are not the first step, and observation is dangerous.