Outpatient Surgery Editors
Best Tip for Malignant Hyperthermia Readiness
How important is prepping for malignant hyperthermia? Just ask the surgical team at Advocate Illinois Masonic Medical Center in Chicago. They used the facility's MH protocol to save a patient's life the very day after the plan had been put in place, says Marge Mehas, BSN, RN, the facility's OR coordinator.
ARM'S LENGTH Store reversal agents and quick-reference cards wherever anesthesia is administered.
After anesthesia induction, the anesthesiologist noticed an unexplained and gradual rise in the patient's end-tidal CO2, potassium and metabolic acidosis levels, heart rate and core temperature. The anesthesiologist and surgeon immediately suspected MH, and the surgical team jumped into action, implementing the protocols they had learned the day before. The surgical and anesthesia team mixed and administered 9 vials of dantrolene, stopped the flow of inhalation anesthetic agents, hyperventilated the patient with O2, changed the anesthesia machine's breathing circuit and administered bicarbonate, glucose and insulin to raise the patient's potassium levels, and began cooling regimens with ice packs and hypothermia blankets. By the time the patient was transferred to the surgical intensive care unit for 24-hour observation, the dangerous physiological levels were corrected. He wasn't out of the woods yet, but he was alive and would survive.
Lessons? Ensure each and every perioperative staff member fully understands how to detect and treat MH, says Ms. Mehas. When MH strikes, summon all available staff members to the bedside of the stricken patient, call the Malignant Hyperthermia Association of the United States hotline (800-644-9737), stop the administration of triggering agents, change the anesthesia machine's breathing circuit, hyperventilate the patient with 100% O2 at 10 liters per minute, administer dantrolene, and cool the patient as needed with hypothermia blankets, ice packs or cold isotonic saline solution.
Run regular MH drills so your staff reacts instinctually during the real deal. The anesthesia provider involved in the life-saving response at Advocate came away impressed. "What a great team effort when every minute counted," he wrote in a congratulatory letter to the surgical team. "During such a rare and potentially lethal event, you did a tremendous job."
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