Keep Your Guard Up for Malignant Hyperthermia
Here's how we keep from being caught unprepared.
Kristi Plank, RN, BSN
The most fortunate among us will never have to deal with a case of malignant hyperthermia. I've been a nurse for 15 years, and I never have. I fervently hope it stays that way. But hoping isn't enough. I want to be prepared, and I want my team to be prepared. After all, those who fail to prepare and who end up having to live with the consequences are among the least fortunate among us.
The next level
Complacency is Enemy No. 1 when it comes to preparations for MH. It used to be that we watched an MH video once a year and took a test afterward. I didn't think that was enough. A lot of actions have to be taken when MH strikes, and they have to be done quickly and correctly. It's asking a lot to expect a group of people who watched a video 11 months earlier to be able to act as a cohesive unit during a life-and-death crisis in which every second counts.
So one of the first things I did was add a mock drill to our yearly training regimen. Nothing in the real world is textbook. You hear about all the signs and symptoms when MH strikes, but you may not actually have all the signs you may only have a couple. It can be confusing. So I try to throw some curves into the mock drills. Maybe the patient doesn't have all the generic symptoms. Maybe in the middle of an MH attack, the patient has a cardiac arrest. Maybe the pharmacy didn't stock enough dantrolene. What are you going to do in those situations?
The first time we did a drill, we learned some things we couldn't have gotten from watching a video. For example, our chilled fluids are locked up in a Pyxis system, so we couldn't ask a scrub tech to go get them. We had to have a nurse be responsible for that job. Also, a lot of people didn't know where our ice machine was. Those are key concerns that you should address ahead of time, not during a real emergency.
Although there were some rough spots, fortunately our major processes were in order. A big reason for that was another improvement I implemented.