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patients are stabilized and transferred to the ICU, they administer one
of the other formulations as maintenance doses while patients are
observed for recurrence.
There are other medications you should have available in MH carts,
including:
• sodium bicarbonate 8.4% to correct acid-base disturbances;
• insulin to treat high potassium levels;
• dextrose 50% to co-administer with insulin to maintain normal
blood sugar levels;
• calcium chloride 10% to protect the heart from severe hyper-
kalemia; and
• lidocaine and amiodarone to treat cardiac arrhythmia.
Also fill the MH cart with the sterile water needed to reconstitute
dantrolene — MHAUS suggests storing the water in 100 vials instead
of bags to prevent accidental IV administration — and supplies for
administering the emergency response drugs, including needles,
syringes and IV catheters.
You can store other supplies you'll need during an MH crisis in the
cart's lower drawers, says Dr. Hamlin. Among the items you'll want to
include: temperature monitoring equipment, transducers for pressure
monitoring of arterial or central venous lines, a urodynamic meter,
Foley catheters, plastic bags to collect ice and single-use ice packs to
help cool the patient.
Some carts have an integrated refrigerator for storing insulin and
cool saline solution (at least 3,000 ml is needed for IV administration,
according to MHAUS) to help lower the patient's body temperature
during an acute MH crisis. Also keep in mind that anesthesia
providers must hyperventilate patients with 100% oxygen at the first
sign of MH onset. You can insert charcoal filters into the anesthesia
machine's breathing circuit to absorb the volatile anesthetics that trig-
