Pharmacology
What are the triggering agents for Malignant Hyperthermia?
Halogen Gasses and Succinylcholine
What is the first action when an MH crisis is suspected?
Discontinue triggering agent and ventilate with 100% Oxygen to flush agent from system and lower ETCO2
True or False: 25% of MH patients have had a prior uneventful anesthetic using triggering agents.
False: 50% of MH patients have had a prior uneventful anesthetic using triggering agents.
Name one of the most frequent and earliest signs of MH
Unexplained elevation of ETCO2 (2-3 times normal)
What is Pharmacy's role in an MH event?
Send a pharmacy tech with the remaining bottles of Dantrolene and reconstitution supplies.
Assist with reconstitution of Dantrolene
Pharmacy department to get additional Dantrolene from SAN.
What is the drug of choice in treating an MH crisis?
Dantrolene
True or False: A known MH susceptible patient should be the last patient of the day because it gives you more time to flush the anesthesia machine.
False. They should be the first patient of the day in that room.
True or False: The current mortality rate from Malignant Hyperthermia is approximately 5%.
True. With the advent of Dantrolene, the mortality rate from Malignant Hyperthermia decreased from 70-80% to approximately 5%.
True or False: Sinus tachycardia is observed in almost all patients as one of the early signs of an MH episode and may be misinterpreted as inadequate anesthesia depth.
True
Name 2 of the circulator's duties in an MH event?
Call for help!
Initiate overhead page "MH Crisis OR Room X" by dialing 55
Assign duties (get MH Cart, get Code Cart, distribute necklaces, call MH Hotline, inform Nursing Sup)
Assist with patient interventions (reconstitute Dantrolene, insert foley, A-line, labs, etc)
How is Dantrolene reconstituted?
With 60cc sterile water
What are the first two phone calls to make when an MH crisis is suspected?
"55" to ensure response of appropriate hospital staff
MHAUS Hotline for additional support
Is the estimated prevalence of MH higher in males or females?
Males at a rate 2.5-4.5 times females.
What is a definitive sign of MH?
General muscular rigidity (masseter muscle rigidity on particular).
Name 3 supplies needed by Dantrolene nurse to effectively do their job?
Sterile Water for injection (1000cc bag on cart)
Spring syringe
Vented spike adapter
Dantrolene vials
60cc syringe
What is the initial dose of Dantrolene?
2.5mg/kg rapidly through a large bore IV
What hospital departments (other than Periop Services) respond to an MH crisis?
Lab and Pharmacy.
True or False: Children and young adults are affected at higher rates than adults.
True
Diagnosis of MH susceptibility can be done by what testing method
Muscle biopsy (specimens exposed to defined concentrations of halothane and/or caffeine and if muscle contractures exceed certain thresholds a diagnosis of MHS (MH-susceptible) is made.
Name 4 of the Cooling Nurse's duties in an MH event?
Discontinue warming blanket if in use
Gather bags of ice
Gather cool fluid for irrigation
Gather cool fluid for lavage
Start cooling at 102 degrees F
Stop cooling at 100 degrees F
Name 3 non-triggering agents of MH.
Propofol, Nitrous Oxide, Opiods, Fentanyl, Ketamine, Local Anesthetics.
You are told by your CRNA that your patient is susceptible to MH. Name 3 actions that you should take before bringing the patient back to the room.
- Clean the anesthesia machine and remove vaporizers.
- Change the lime canister.
- Add orange VaporClean filter to circuit.
- Flush the new circuit with O2 for 10-20 min prior to use.
- Use non-triggering agents, MAC, local, or regional anesthetics.
- Bring MH cart into the room.
At what temperature are cooling measures initiated and at what temperature are they discontinued?
Start at greater than 39 degrees C (102 degrees F)
Stop at less than 38 degrees C (100 degrees F) to allow for continuing downward shift.
Name another condition that mimics MH and needs to be considered in light of patient signs and symptoms?
Inadequate depth of anesthesia; Insufficient ventilation; Malfunction of anesthesia machine
Sepsis
CO2 increase due to laparoscopic procedure
Anaphylactic reaction
Name 5 things the recorder must document?
Time MH Crisis is determined
Time MH Crisis is paged overhead
Time MH Hotline called
Time of Medication administration
Time cooling techniques initiated
Time interventions are done (foley, NG tube, A-line, additional IV, etc.