You just finish dropping your patient off in PACU and one of the RNs come up to you and want you to look at a patient. Patient is a 45yo F S/P thyroidectomy sitting up at 90 degrees with a NRB on and obviously struggling with retractions. SpO2 100%. You notice the neck is definitely enlarged and the RN states it has gotten bigger in the last 20min. Patient tells you she is having a hard time breathing and you can see it is difficult for her to finish a sentence before taking a gasp.

What do you do first and what is your plan?