QUICK DRAW During MH drills, staff at Holy Redeemer Hospital draw up expired dantrolene to make training sessions more realistic and effective.
Many surgical professionals learn best by doing. If you bombard them with information about what to do in the event of a malignant hyperthermia (MH) emergency, but don't give them a chance to physically go over the many critical steps they need to take, chances are they won't be fully prepared when a real crisis hits. MH might be rare, but its related complications are serious, so engaging and easy-to-retain simulation training is a must.
1. Create realistic scenarios
While planning our facility's MH training program, I told Rob Simon, CRNA, our facility's chief nurse anesthetist, to make sure staff didn't spend 40 minutes sitting around listening to a lecture they'd likely forget right after it ended. That's all Rob, a skilled clinician who also serves as a professor at a local university, needed to hear.
He created three real-life patient scenarios to guide our education and training efforts. If you're creating scenarios, you want to be as specific as possible. For instance, one of the scenarios dealt with a patient whose MH symptoms came on in the PACU — something that can occur, but is often overlooked during training. With this type of scenario, you want to teach staff how to spot the early physical symptoms — such as muscle rigidity — that present when there's no end-tidal CO2 monitoring to reference.
2. Spell out action steps
There are specific ways staff members must respond to the first signs of MH. We wanted response protocols to be as clear and concise as possible for our OR team, so Rob created a bulleted, step-by-step review guide of every critical action necessary to resolve a crisis based on information from the Malignant Hyperthermia Association of the United States (mhaus.org). The guide needs to cover everything your staff needs to do without confusing them in the process (see the sidebar below). For instance:
Stop: Immediately discontinue the volatile anesthetic and succinylcholine.
Help: Call for help and alert the surgeon to conclude the procedure promptly.
Administer Dantrolene: Prepare and administer 2.5 mg/kg dantrolene IV bolus and repeat as necessary every five to 10 minutes until symptoms abate.
