Archive Anesthesia 2016

Stay on Guard Against Malignant Hyperthermia

The best drills simulate the urgency of a real life-or-death crisis.

Courtney Yost, BSN, RN, CNOR, RNFA


simulations MIXED BLESSING Using expired dantrolene, which can be physically demanding to reconstitute, helps make simulations as realistic as possible.

Are you confident your staff could handle a malignant hyperthermia crisis? Although you won't know for certain until they experience the pulse-pounding pressure of racing against time during an actual life-or-death event, you can organize realistic drills that have your staff run through the response protocols needed to save a stricken patient. Someday the call might come that puts all their training to the ultimate test. Here's how to make sure every member of your staff is prepared to react quickly and calmly when it does.

1 Tailor the learning
I'd never once participated in an MH simulation in my 16 years of OR nursing, let alone experienced an actual event. But a colleague of mine, Rebecca Albert, BSN, RN, has. Along with another colleague, Lee Ann Quave, MSN, RN, we decided it was time to identify gaps in our staff's understanding of MH and tailor our educational efforts and drills accordingly.

We used a variety of sources, including the National League for Nursing's simulation design template and material from AORN, and expanded on those to create our own drill. To establish a knowledge baseline, we administered a test before the simulation, while planning to re-administer it after. Not surprisingly, the test and subsequent simulations revealed numerous areas for improvement, not just for those who took part, but also for those of us who designed them.

2 Understand the warning signs
One of the deficiencies we found among staff members who thought they knew a fair amount about MH was the misconception that high temperature is one of the early signs. In reality, it's usually one of the later signs, following an increase in end-tidal carbon dioxide, rapid heartbeat, muscle rigidity and rapid breathing. And in our research, we learned that early recognition of symptoms is a huge factor in improving survival.

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