MH - Malignant Hyperthermia
Where do you find the MH Crisis Hotline?
Answer: On the MH Cart
SDMC MH Cart is located in PACU
MH Hotline: 1-800-644-9737
Identify steps to take if Universal Protocol patient safety elements are not completed before the procedure begins
Answer: File a PSR
Briefing: Name of the patient, the procedure to be performed, the site/side of the procedure, patient positioning, implants and radiological exams that are applicable
Debriefing: performed at the end of the surgical procedure prior to the surgeon & patient leaving the OR suite and included confirmation of correct counts, surgical procedure, wound class & specimen identification and labeling
Is it ever acceptable to re-advance a Central/PICC line if it slightly pulled out from the original insertion length during a dressing change? Give at least one 1 reason.
Answer: NO!!
Risk of embolism, infection risk, damage to vessel or catheter, loss of proper position, regulatory and clinical guidelines
Give at least 5 universal safety measures to prevent fall
Answer: Call light, lowest position of bed with wheels locked up and side rails up, non- skid footwear, personal items within reach, hourly rounding, educate patient and family to call for assistance, clean and tidy room
Skin prep antiseptics are fire safety. True or false and why?
Answer: True, they are flammable
The main treatment for MH is a drug called? and how many vials are there inside the MH Cart?
Answer: Dantrolene, 36 Vials
Each vial mixed with 60 ml of Sterile water. Administer 2.5 mg/kg initial bolus with increments of 10mg/kg total
What is the purpose of Universal Protocol SDMC policy? Give all 3 possible answers.
Answer: To prevent wrong patient, wrong site and wrong procedure.
Universal Protocol is associated with National Patient Safety Goal by JCAHO
How many ml of N/S of pulsatile flush do you need after TPN/Lipid or blood transfusion and give at least 1 reason why.
Answer: 20 mls
To prevent from catheter occlusion, clearing residual fluids, ensure proper function of the line, preventing from fluid/drug interaction, maintaining line sterility
What documentations are required after a patient had a fall? Give at least 3
Answer:
1. PSR
2. Significant event
3. Update care plan
4.Update fall risk status
Which of the following is considered the greatest risk factor for complications related to anesthesia during the preoperative period?
A) Obesity
B) Age over 60
C) Smoking history
D) History of substance use disorder
Answer: A) Obesity
Rationale: Obesity increases the risk of complications during anesthesia, such as difficulty with intubation, respiratory issues, and cardiovascular strain.
MH can occur anytime during _____________ and _____________.
Answer: Intra-operative and Post Operative
Triggering Factors: IV Succinylcholine, Inhalers: Desflurane, Sevoflurane, Isoflurane, Any muscle relaxant
What are the components of Time out? Who is included in a Time out?
Answer: The name of the patient, the procedure, and the site. The whole surgical Team
Sign in & Anesthesia Block Time out - led by anesthesiologist with circulating nurse
Time out - led by surgeon
Sign Out - Verbal confirmation RN led completed by team
When do you remove a bad PIV?
a. Once a new PIV is established just in case of emergency
b. Immediately
c. As soon as possible
d. A and C
Answer: B. Immediately
To prevent complications such as infections, infiltration/extravasation, phlebitis, clot formation/thrombosis, patient comfort
What are your immediate actions for post fall event?
Answer:
1. Activate Code falling star
2. RNs must assess the patient at the time of incident
3. RN will determine the safest way to move the patient back to safe location, based on mobility assessment
4. Notify the physician in SBAR
5. Notify the family as appropriate
Which of the following actions is most important for preventing surgical site infections (SSIs) during the intraoperative phase?
A) Administering prophylactic antibiotics within 1 hour before the surgical incision
B) Using a surgical drape that does not allow any exposure of the patient’s skin during the procedure
C) Maintaining the patient’s body temperature between 36-37°C (96.8-98.6°F) throughout the procedure
D) Restricting traffic in the operating room to only essential personnel during the procedure
Answer:
A) Administering prophylactic antibiotics within 1 hour before the surgical incision
Rationale: Prophylactic antibiotics are most effective when given within 1 hour before the incision to prevent infection.
What are the early signs of MH? Give at least 3
Answer: Generalized Muscle Rigidity and rigid Jaw, Unexplained Tachycardia, Unexplained increase in exhaled C02, Temperature increase, Tachycardia, Tachypnea
Note: Later signs: Dark urine, bleeding/oozing from the wound
This is required for all procedures that involve an incision, percutaneous puncture, or insertion of an implant or instruments into the body.
Answer: Site Marking
Exception as per SDMC policy ex. procedures in a non-surgical setting (central venous access or labor epidural anesthesia), endoscopies, when a site is not pre-determined
If a patient has PICC line and it has migrated out 2 cm from the initial insertion external catheter length. What is your next step?
a. Leave it as it is because 2 cm is not that much
b. Notify MD to request chest x-ray to confirm tip location
c. Re-insert back
d. Request order to remove PICC line
Answer: B. Notify MD to request chest x-ray to confirm tip location
Ensuring correct placement, prevent complications, guidance for malposition, standard of care and guidelines
These types of patients are more prone to skin breakdown.
a. Obese patient
b. Elderly patient
c. Post partum patient
d. Male ambulatory
Answer: Elderly pts
Which of the following medications should be withheld prior to surgery to reduce the risk of excessive bleeding?
A) Aspirin
B) Lorazepam
C) Metformin
D) Lisinopril
Answer: A) Aspirin
Rationale: Aspirin is an antiplatelet agent and should be withheld before surgery because it increases the risk of bleeding.
Survival of MH patient is highly dependent on? Give at least 3.
Answer: Early recognition of signs and symptoms, Cart and supplies in close proximity, Timely administration of Dantrolene, Knowledgeable staff
Note: To treat rapid increase of temperature, use Ice packs and cold IV fluids
Staff verifies the correct person (name and either DOB or MRN), correct site, and correct procedure at the following times (name at least 4).
Answer: Upon scheduling the procedure, Before any pre-admission testing and assessment, At time of admission/entry into the facility for procedure whether elective or emergent' Before the patient leaves the pre-op holding area or enters the procedure room, Before regional blocks, During surgical time-out, Anytime the responsibility for care is transferred to another member of the procedural care team at the time of, and during the procedure
Give 3 signs and symptoms of an infected access.
Answer: redness, swelling and discharge/drainage.
If a new pressure injury is present, the RN must? Give 5 possible answers
Answer:
1. Notify the medical provider
2. Consult wound specialist
3. Complete the LDA/WALDO
4. Take photos of the wound
5. Fill out PSR
Name 5 risk factors for VTE
Answer:
History of prior VTE
•Age
•Obesity
•Cancer
•Medical comorbidities, ASA score
•Pregnancy
•Immobility (>72h)
•Hormone exposure, e.g. estrogen therapy
•Smoking
•Mode of surgery (laparotomy)
•Length of surgery (>2 hours)
•Case complexity (emergent > elective)
•Case type (major abd/pelvic)
•General anesthesia
(reference ACOG PB 232)