It is 1100 hours on Saturday morning and you are working in a large metropolitan hospital. You have just finished a case when you are phoned by the registrar in the high dependency unit.
An 84-year-old man who underwent neck dissection for melanoma two days ago is now in respiratory distress. A large right-sided neck swelling has developed over the last two hours.
His SpO2 is 97% on 15 l/minute of oxygen; his blood pressure is 140/80 mmHg and his heart rate is 95 /minute.
He has a background history of atrial fibrillation and transient ischaemic attacks, for which he takes dabigatran, 110 mg twice daily, as his only medication.
Dabigatran was ceased two days preoperatively and recommenced orally three hours ago. He was bridged with enoxaparin; the last dose of enoxaparin 1.5 mg/kg was 12 hours ago.
You have two minutes to consider the case as you proceed to the high dependency unit.