Medications & All About That Dose
This is the name of the current medication that is used to treat malignant hyperthermia?
What is RYANODEX (dantrolene sodium)?
In malignant hyperthermia, there is an increase in this entering the cells, causing skeletal muscle rigidity.
What is Calcium?
This is how many mls you need to reconstitute a vial of RYANODEX.
What is 5ml?
1 vial of Ryanodex contains the same amount of dantrolene sodium as this many vials of other approved datrolene sodium formulations.
What is 12.5 vials?
These are some of the first things you do if you suspect MH.
What is...?
-Stop the procedure
-Call for help (including having the operator announce a MH code overhead)
-Get the MH cart
-Make sure all potent inhaled anesthetic agents have been dc'd.
-Hyperventilate with 100% O2
-Reconstitute Ryanodex
-Call the MHAUS Hotline (for assistance during acute and post-acute phase)
This is the name of the old medication used to treat MH prior to the one we use now.
What is Revonto/Dantrium?
These are early signs of MH.
What is...?
-Muscle contraction & rigidity (masseter & truncal muscles after Succinylcholine)
-Hypercarbia (increase in ETCO2)
-Metabolic and respiratory acidosis
-Rapid change in the color of the CO2 absorbent cannister and warm to the touch
-Tachypnea
-Unexpected tachycardia & possible arryhthmias
You need this type of solution to reconstitute RYANODEX.
What is sterile water (without a bacteriostatic agent).
These surgical procedures are associated with an increase incidence of MH.
What is...?
-Orthopedics
-Repair of cleft palate
-T&A
-Repair of Ptosis
-Strabismus correction
These are ways you can cool your patient if MH is suspected.
What is...
-Decrease the temperature of the room
-Infuse cold IV fluids
-Apply ice externally (axillary regions, groin, neck)
-Lavage open body cavities
-Irrigation of body cavities if surgical wound is open
*Cool until patient reaches <38C (100.4F)
This is the loading dose of RYANODEX?
What is 2.5mg/kg IV push?
*One vial is enough medication for a loading dose of a patient weighing up to 100kg.
*2.5mg/kg is given every 15 minutes until signs of hypermetabolism (acidosis, pyrexia, muscle rigidity) are resolving.
These are late signs of MH.
What is...?
-Fever (often >105)
-Myoglobinuria (brownish-cola, tea colored urine)
This is the color the solution should be once a bottle of RYANODEX is reconstituted.
What is orange?
This population is at highest risk for developing malignant hyperthermia.
What is people with a family history of MH?
*MH is an autosomal dominant genetic disorder, so if the parent has the gene that causes it, their child has a 50% chance of inheriting it too! Other relatives with MH also increase the risk.
This is where the MH cart is located.
What is in the OR core, to the right of OR 7, across from OR 8.
There is 125mg of this in each vial of Ryanodex.
What is Mannitol?
These are complications from MH.
What is...?
-Bleeding/oozing from the wound site (check for DIC)
-Kidney damage or failure
-Death
Once reconstituted, you must use the vial of RYANODEX within this time frame.
What is 6 hours?
This age group has a higher incidence of developing MH.
What is patients less than 50 years old and particularly the pediatric population?
These are some other medications you might expect to give during an MH crisis.
What is...?
-Propofol +/- a benzodiazepine
-IV Insulin + D50
-Calcium Chloride or Calcium Gluconate
-Ammiodorone
-Sodium Bicarbonate
-Normal Saline
-Mannitol
-Epi/Norepi infusions
This is the max cumulative dose of Ryanodex.
What is 10mg/kg?
These medications are triggering agents for MH.
What is Succinylcholine and volatile anesthetic gases (Sevoflurane, Halothane, Isoflurane, Desflurane)?
1 vial of RYANODEX contains the same amount of dantrolene sodium as this many vials of other approved dantrolene sodium formulations.
What is 12.5 vials?
These are the labs you should expect to draw during a suspected MH crisis.
What is...?
-Arterial blood gas
-Electrolytes (glucose, calcium, magnesium, phosphate, CK)
-Serum/urine Myoglobin
-LDH
-AST
-CBC
-PT/PTT, INR, fibrinogen, D-Dimer
This is the emergency phone # for the 24-Hour MHAUS Hotline
What is 1-800-644-9737 (800)-MH-HYPER