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    Hypertermia Crisis

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    lisa
    management of malignant hyperthemia

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    Hypertermia Crisis

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    lisa
    488 views1 page
    management of malignant hyperthemia

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    © © All Rights Reserved

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    management of malignant hyperthemia

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    488 views1 page

    Hypertermia Crisis

    Uploaded by

    lisa
    management of malignant hyperthemia

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Malignant Hyperthermia Crisis

    AAGBI Safety Guideline


    Successful management of malignant hyperthermia depends upon early diagnosis and treatment;
    onset can be within minutes of induction or may be insidious. The standard operating
    procedure below is intended to ease the burden of managing this rare but life threatening emergency.

    1 Unexplained increase in ETCO2 AND


    Unexplained tachycardia AND
    Unexplained increase in oxygen requirement
    Recognition (Previous uneventful anaesthesia does not rule out MH)

    2


    STOP all trigger agents (anaesthetic vapours, etc.)
    CALL FOR HELP. Allocate specific tasks (action plan in MH kit)
    Install clean breathing system and HYPERVENTILATE with 100% O2 high flow
    Immediate Maintain anaesthesia with intravenous agent
    management ABANDON/FINISH surgery as soon as possible

    3
    Give dantrolene DANTROLENE
    2.5mg/kg immediate iv bolus.
    Initiate active cooling avoiding Repeat 1mg/kg boluses as required
    vasoconstriction
    Monitoring to max 10mg/kg

    & treatment TREAT: For a 70kg adult


    Hyperkalaemia: calcium chloride, Initial bolus: 9 vials dantrolene
    NaHCO3, glucose/insulin 20mg (each vial mixed with 60ml
    sterile water)
    Arrhythmias:
    magnesium/amiodarone/metoprolol Further boluses of 4 vials
    AVOID calcium channel blockers - dantrolene 20mg repeated up to
    interaction with dantrolene 7 times.
    Continuous monitoring
    Metabolic acidosis: hyperventilate, Core & peripheral temperature
    NaHCO3 ETCO2
    SpO2
    Myoglobinaemia: forced alkaline ECG
    diuresis (mannitol/frusemide + Invasive blood pressure
    NaHCO3) may require RRT later CVP
    DIC: FFP, croyprecipitate, platelets Repeated bloods
    ABG
    Check plasma CK as soon as able U&Es (potassium)
    FBC (haematocrit/platelets)
    Coagulation

    4
    Continue monitoring on ICU, repeat dantrolene as necessary
    Monitor for renal failure and compartment syndrome
    Repeat CK
    Follow-up

    Consider alternative diagnoses (sepsis, phaeochromocytoma, thyroid storm, myopathy)
    Counsel patient & family members
    Refer to MH unit (see contact details below)

    The UK MH Investigation Unit, Academic Unit of Anaesthesia, Clinical Sciences Building, St Jamess University Hospital Trust,
    Leeds LS9 7TF. Direct line: 0113 206 5270. Fax: 0113 206 4140. Emergency Hotline: 07947 609601 (usually available outside
    office hours). Alternatively, contact Prof Hopkins or Dr Halsall through hospital switchboard: 0113 243 3144.

    Your nearest MH kit is stored


    This guideline is not a standard of medical care. The ultimate judgement with regard to a particular clinical procedure or treatment plan must be made
    by the clinician in the light of the clinical data presented and the diagnostic and treatment options available.
    The Association of Anaesthetists of Great Britain & Ireland 2011

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