Clinical MH Intro
Patients who are most susceptible to MH have this type of autosomal dominant disorder
What is "inherited"
Learning Point:This means that children, parents and sibs of an MH susceptible have a 50% chance of inheriting MH susceptibility. Aunts and uncles of the MH susceptible and grandchildren have a 25% chance.
Location of the MH Cart for the perioperative area
BONUS: Location and door code for the 2nd MH Cart at PMCE hospital
What is the Anesthesia Workroom
BONUS: What is ER, POD C, 5100*
This is the number dialed and the type of emergency code response announced in response to a MH Crisis in an adult patient.
BONUS: Who else do you immediately call to get the MH cart?
What is Dial "111" and announce Code Blue
BONUS: Who is the Charge RN to announce a "MH Crisis OR room#____and request she/he bring the MH Cart.
Minimum number of RNs assigned to mixing Dantrium
What is 2
(Preferably 2-4)
Clinical Symptoms to observe to know when to stop giving the 2.5mg/kg dose of Dantrium
BONUS: Length of time to continue to treat a patient with Dantrium after a MH Crisis is resolved in order to prevent/observe for a potential relapse
What are signs of reversal of the acute MH symptoms (decreased ETCO2, decreased muscle rigidity, and/or lowered heart rate)
BONUS: 24-48 hrs (1mg/kg dose q 4-6 hrs or can give via a drip infusion 0.25mg/kg/hr)
An MH crisis is “triggered” by these agents
What are are inhaled general anesthetics and succinylcholine
This is the only known drug therapy for reversing MH which acts by binding to the RYR1 receptor to inhibit the release of calcium from the sarcoplasmic reticulum
What is Dantrium/Revonto (20mg vial)
BONUS: What is Dantrium mixed with? ___ml of ____ solution
Alternative Drug: Ryanodex(250mg vial) (we do not stock) (mixed w/5ml of sterile preservative free water)
The immediate clinical response by the anesthesia provider once a he/she has suspected a MH Crisis.
Announce the MH Crisis to Surgeon and Team! Turn off all anesthetic gases, and hyperventilate the patient 100% O2 to flush out anesthetic gases and lower the patient's ETCO2. Use non-triggering agents.
(Consider using a new breathing circuit and the OR Room ambu bag and O2 tank until MH Cart arrives. Call Respiratory for a Ventilator)
Flush the anesthesia machine with 100% O2 and apply inspiratory and expiratory charcoal filters from the MH Cart.
Obtains ice and runs blood work to the lab, assist to gather additional equipment/supplies as needed
Who is the Periop Tech
The TIME within which reconstituted Dantrium must be given
AND
the THING it must be protected from
What is 6 hours and Light
EARLY warning signs of an impending MH Crisis
BONUS: Normal range for ETCO2 level
What is unexplained increased End Tidal CO2 level, Unexplained Tachycardia, Tachypnea, Muscle Rigidity
(increased temp. usually a later sign, as well as dark blood, dark brown colored urine, arrhythmias)
BONUS: What is 35-45mmHG
Weight based dosing of the drug used to reverse a MH Crisis
What is 2.5mg/kg of Dantrium/Revonto given rapidly in large bore IV (if possible)
This 24 hr. consultant hotline consisting of on-call anesthesiologists to provide expert help in treating a MH crisis
What is the MH Hotline (MHAUS Hotline)
Learning Notes: The Hotline will request your name, number, facility and email, in the event the call is dropped
MH Hotline number is located on phones in OR rooms, in MH Lucidoc procedure, and on front of MH binder on cart.
Helps to prepare an arterial line, draw labs, and other duties as assigned by the anesthesiologist/attending
Who is the Anesthesia Tech and RN
Dantrium Dosing Chart can be found here
What is the PH Malignant Hyperthermia Lucidoc Procedure
Safe anesthetic agents for a MH susceptible patient or for a MH crisis patient
What is a Narcotic, Barbiturate / Intravenous Anesthetic, Nitrous Oxide, Muscle Relaxant (excluding Anectine or Succynolcholine), Anti-Anxiety Medication, Any Local Anesthetic
In a MH Crisis, these filters are used to capture exhaled anesthetic gases from the patient and prevent residual anesthetic gases that may be present in the anesthesia ventilator from reaching the patient
BONUS: How often do these charcoal filters have to be changed in a MH Crisis?
What are the Charcoal Filters (Vapor Clean Filters)
Bonus: What is every 60 minutes
This is the core body temperature at which the patient should start to be cooled in a MH Crisis
BONUS: To prevent unintentional "hypothermia" stop cooling the patient at this core body temperature
What is greater than 39 degrees Celsius
BONUS: What is 38 degrees Celcius
Designated timekeeper and documents the events of the MH crisis
Who is the RN (Circulator, Charge, Supervisor)
Ways to control hyperthermia in a patient who is having an MH reaction
--What is administer Refrigerated N/S IV fluids (South Core Pyxis); --What is Pack the patient in ice (ice machines in PACU & Cafeteria; --What is Perform Cold lavage if open body cavities or gastric/rectal/bladder lavage as needed
Mutations in this gene are considered to account for susceptibility to MH in more than 50% of cases and is an important gatekeeper for calcium release from the sarcoplasmic reticulum in muscle tissue.
What is the ryanodine receptor [RYR1] defect on chromosome 19
When dantrolene has been administered, do not use these type of "blocking agents" as they can interact to produce fatal hyperkalemia and cardiovascular collapse.
What are "Calcium Channel Blockers"
Given to treat Acidosis
What is Sodium Bicarbonate
Assists the surgeon to cool the patient's body cavity, assists to finish surgery, and closely monitors the sterile field, may need to assist in chest compressions if cardiac arrest occurs
Who is the Surgical Technologist or RN Scrub
This test is the current "gold standard" test for MH
What is the Caffeine-Halothane Contracture Test (CHCT)
(muscle biopsy)