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Archive Anesthesia 2020

Are You Ready for an MH Emergency?

Realistic training ensures staff act quickly and confidently during a real crisis.

Kimberly Macasieb

Kimberly Macasieb, MSN, RN, CNL, CNOR


VA Southern Nevada Healthcare System
NO DUMMY Instead of mannequins, the VA Southern Nevada Healthcare System used real staff and simulated dantrolene to the make MH simulation training as realistic as possible.

Our annual training for malignant hyperthermia (MH) emergencies used to be expected and ordinary. We sat through classroom learning, watched an educational video and clicked through a PowerPoint. It was boring and no one was engaged. It seemed like we tolerated training just to check a box to say we did it. We knew it could be better. Given the stakes, it had to be better.

MH is a potentially fatal, inherited disorder usually associated with the administration of triggering agents such as general anesthetics and/or succinylcholine. If an MH crisis isn't treated promptly, the patient can suffer severe complications such as cardiac arrest, brain damage, internal bleeding or failure of other body systems, according to the Malignant Hyperthermia Association of the United States (MHAUS). MH occurs in about one in 100,000 surgeries in adults and in one in 30,000 surgeries in children, according to MHAUS.

Most OR teams will never experience an MH crisis, so when it does happen, it can be hard to recognize and cause panic. Given the life-or-death nature of MH, we needed to better prepare staff for the real deal and decided to transition to simulation training. Practicing response protocols and teamwork in a tense, realistic situation gives staff the practice needed to feel confident they'll react appropriately and promptly during a real crisis, when every second counts.

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