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Item: Laminated poster
Item Code: ORPO
Last revised: 2015
Size: inches: 16" x 24"
Description: Emergency Therapy for Malignant Hyperthermia Protocol to display anywhere a MH Crisis may occur.
February 2015 changes from September 2011
added: (despite hyperventilation) to Signs of MH: Increasing ETCO2
added: Male to Sudden/Unexpected Cardiac Arrest in Young Patients
added: Myogobinuria is common
Acute Phase Treatment
added: Call MH Hotline to GET HELP. GET DANTROLENE. Notify Surgeon
added:If available insert activated charcoal filters into the inspiratory and expiratory limbs of the breathing circuit. The Vapor-CleanTM filter may become saturated after one hour; therefore, a replacement set of filters should be substituted after each hour of use to Hyperventilate with 100% oxygen of flows to 10L/min.
removed: the words "or more" from Hyperventilate with 100% oxygen of flows to 10L/min.
added: Dantrium® / Revonto® / Ryanodex® to 2.5 mg/kg rapidly IV, if possible through large-bore IV
added: Dantrium/Revonto – Each 20 mg vial should be reconstituted with at least 60 mL sterile water for injection, USP (without a bacteriostatic agent). There are 3 grams of mannitol in each 20 mg vial of Dantrium and Revonto.
added: Ryanodex – Each 250 mg vial should be reconstituted with 5 mL sterile water for injection, USP (without a bacteriostatic agent) and shaken to ensure an orange-colored uniform, opaque suspension. There are 125 mg of mannitol in each 250 mg vial of Ryanodex.
removed: each 20 mg bottle has 3 gm mannitol for isotonicty. The pH of the solution is 9.
added: hypothermia to Stop cooling if temperature <38 degrees C and falling to prevent drift <36 degrees C.
removed: drift,36 degrees C. from Stop cooling if temperature <38 degrees C and falling to prevent.
Post Acute Phase
added: Watch for MH relapse by continuously evaluating the patient for at least 24 hours following cessation of signs of MH. 25% of MH events relapse, which can be fatal. Treat immediately if relapse occurs. Signs of MH relapse include: • Increasing muscular rigidity in the absence of shivering • Inappropriate hypercarbia with respiratory acidosis • Metabolic acidosis without other cause • Inappropriate temperature rise.
removed: Observe the patient in an ICU for at least 24 hours, due to the risk of recrudescence.
added: Give dantrolene, 1mg/kg IV q 4-6h or 0.25mg/kg/hr by infusion and continue for at least 24 hr and sometimes longer as clinically indicated. Dantrolene can be stopped, or the interval between doses increased to q8h or q12h if all of the following criteria are met: • Metabolic stability for 24 hours • Core temp is less that 38°C • CK is decreasing • No evidence of myoglobinuria • Muscle is no longer rigid Follow vital signs and labs as above
removed: Further does may be indicated.
added: blood gasses
September 2011 changes from March 2008.
Last bullet to read observe in PACU or ICU for at least 24 hours
Acute Phase Treatment:
#2 DELETE AS NO LONGER APPROPRIATE WITH THE NEW FAST DISSOLVING VERSIONS.... Prewarming (not to exceed 39°C.) the sterile water may expedite solublization of dantrolene. However, to date, there is no evidence that such warming improves clinical outcome. (remove statement according to PAC)
#4 cool the patient with core temperature > 39 degrees C.
Lavage open body cavities. Apply ice to surface.
Infuse cold saline intravenously. Other cooling techniques may be applied at clinician's discretion.
Stop cooling if temp. < 38 degrees C and falling to prevent drift < 36 degrees C.
#6 CHANGE BULLET #2 TO READ – for pediatric, 0.1 units insulin/kg and 2ml/kg 25% Dextrose or for adults, 10 units regular insulin IV and 50 ml 50% glucose
Under B: add the following "and sometimes longer as clinically indicated” to the end of the statement.