Response steps to an MH crisis
When your patient develops malignant hyperthermia (MH), take these steps, providers suggest:
- Differentiate between signs and symptoms, and rule out other causes.
The symptoms and signs of MH can be confused with many more common issues and problems, says Jeffrey Jacobs, MD, an anesthesiologist at Cleveland Clinic in Weston, FL. You have to quickly rule out other causes, he says.
"With nonspecific signs and symptoms, and the patient is not getting better with normal intervention, and they have received triggering agents, that's when you start to believe you might be in an MH crisis," Jacobs says.
- Respond quickly.
Keep the poster describing how to perform emergency therapy to treat MH and the toll-free number of the Malignant Hyperthermia Association of the United States (MHAUS) by the crash cart and the dantrolene supply, sources suggest.
Follow the changes in the patient to determine right away whether MH is the cause, warns Debra Merritt, CRNA, MSN, liaison from the American Association of Nurse Anesthetists to the (MHAUS). "It can take off and become lethal very quickly," she warns.
Jacobs agrees. "When you accept it's MH, the body already has a head start on it, going into a hypermetabolic state," he says.
- Administer dantrolene.
The typical starting dose of dantrolene is 2.5 mg per kg, according to Jacobs. "For a 160-pound person, that's about six or seven bottles of dantrolene," he says.
Keep in mind that the resuscitation effort takes several people, Jacobs says. "You need one person to devote themselves to mixing, another to administer it, and another to take care of the patients' blood pressure and IV access."
Administer dantrolene until the signs and symptoms of hypermetabolism are under control, Merritt says. "The heart rate is decreasing, the end-tidal CO2 is decreasing, and the temperature is decreasing," she says. "You're stabilizing the patient." [Protocol from MHAUS is available.]
When your patient develops malignant hyperthermia (MH), take these steps, providers suggest:You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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