Malignant Hyperthermia (MH) Nursing Interventions for Certified Perioperative Nurse (CNOR)
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Outline
Malignant Hyperthermia (MH) Nursing Interventions
Guidelines:
- Often fully identified post-op
- Triggers
- Anesthetic gasses (“ane”)
- Succinylcholine
- Unknown
- Rhabdomyolysis
- Family history, muscle biopsy
- Previous exposure does not guarantee safety
- DANTROLENE
- MH cart
- Cold IVF
- Ryanodex (brand name, $$, important to know which you have)
Considerations:
- Recognize-act
- Rising-etCO2
- fighting vent settings
- Tachy
- Acidotic
- “Marathon”
- Hyperthermia
- could be late
- Rhabdo- late sign
- Rigidity- masseter typically visible
- 1:100,000, 2:1, m:f
- MH chart checks
- Training!
- DIC late sign, with end stage organ fail
Nurse’s role:
- Nurse’s role
- Awareness/identification
- Dantrolene party
- Screening
- Labs/foley/ICU
Pitfalls:
- Failure to identify
- Statistical probability dismissal
- Previous exposure
- Low volume high risk
- Cart
- Training
Examples:
- Pt arrived in PACU,tachy, hypertherm, rigid, arrhythmia (suspect MH, activate protocol, Anes stat, dantrolene party)
Linchpins (Key Points):
- MH must be identified and treated quickly, butthe low frequency makes this treatment particularly high risk
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Transcript
References
- Association of periOperative Registered Nurses. (2022). Guidelines for Perioperative Practice (2022 ed.).
- Rosenbaum, H & Rosenberg, H (2022). Malignant hyperthermia: Diagnosis and management of acute crisis. UpToDate. https://www.uptodate.com/contents/malignant- hyperthermia-diagnosis-and-management-of-acute-crisis
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