Malignant Hyperthermia
Drug of choice for a Malignant Hyperthermia crisis?
Ryanodex
(Dantrolene)
An airway assessment of:
inspiratory stridor
rapidly decreasing oxygen saturation
absence of breath sounds
complete obstruction to ventilation
are all signs of __________.
Laryngospasm
Transport endoscopes to FERC within __________ minutes after use
60
What does LAST stand for?
Local anesthetic systemic toxicity
J-tip should NOT be used on babies weighing less than ______?
4 kg
J-Tip for Local Analgesia v.5
What are malignant hyperthermia triggering agents?
Volatile gases: “fluranes”
Desflurane
Enflurane
Halothane
Sevoflurane
Isoflurane
Enflurane
Muscle relaxant:
Succinylcholine
What medication is used to break a laryngospasm?
Propofol can be used alone or with the use of succinylcholine
Burn dressing consents needed with?
debridement
Early signs and symptoms?
Numbness around mouth, cheeks, chin
Ringing in ears
Dizziness
Metallic taste
What should you look for before getting labs?
Expected dates
Who determines discharge for MH?
And what is required?
Anesthesia
An order from anesthesia
What type of trach is MRI safe?
Why?
Shiley
Remember: Bivona trach tubes have a metal coil in them to help the silicone retain its shape
When delivering CSF to microbiology or specimen control make sure to _________
Ring the bell and have someone physically take the sample from you
Treatment for LAST?
20% Lipid Infusion
Benzodiazepines, if seizing
Prior to the beginning of any laser-based procedure, nursing personnel will ensure that:
1) “Laser in Use” signs are activated
2) Goggles/glasses are used
3) Door is closed and the locked
4) Reflective surfaces are covered or blackened
Late Signs of MH?
Early Signs of MH?
Early:
Increased CO2
Muscle Rigidity
Increased Heart Rate
Increased Respiratory Rate
Temperature
Late:
Respiratory/ Metabolic Acidosis
Heart Arrhythmias
Elevated Blood Potassium
Temperature
What medication is used to dry up secretions?
What are two common side effects of the medication?
Glycopyrrolate
Flushed cheeks
Increased heart rate
Vapocoolant should NOT be used under the age of _________
4, or those developmentally/ cognitively unable to understand the product
Where are lipids kept on LL2?
Procedural Med Room (cabinet above computer)
For a baby less than 3 months, LMX can be left on the skin up to ___________ minutes.
For children over 3 months old, it can be left on the skin up to _____________ minutes.
Reconstitute each 250 mg vial of Ryanodex with?
5 mL Sterile Water
(use within 6 hours)
Managing laryngospasm, what do you do first?
YELL FOR HELP!!!!
Open airway with jaw thrust
Apply positive airway pressure
A PAED score of _______, requires paging anesthesia, diminish stimuli, administer opiate, additional anesthesia interventions
Greater than 15 (Severe)
What cardiac signs/ symptoms to watch for?
Vitals after Walia injection?
Bradycardia, hypotension, heart block
Full set of vitals every 5 minutes x3 sets
6 months or younger who receive IV opioids in any phase of care need to be monitored for _________
Minimum of 4 hours following administration of opioid