5. How much dantrolene do you need?
This depends on which of the 2 currently available formulations you
choose to stock. Dantrium (Par Pharmaceutical) and Revonto (US
WorldMeds) come in 20 mg vials that require 60 ml of sterile water
to reconstitute. You should stock 36 vials of each formulation to
have enough on hand to stabilize the patient. Ryanodex (Eagle
Pharmaceut-icals) comes in 250 mg vials that require 5 ml of sterile
water to reconstitute. You should stock 3 vials of the drug to stabi-
lize the patient. Store enough vials on the MH cart to deliver the ini-
tial stabilizing dose an initial dose at 2.5 mg/kg within 5 minutes of
MH being diagnosed, but have a plan in place to obtain more vials as
needed.
Ideally, we assign 3 or 4 nurses to reconstitute the dantrolene. They
use IV spikes instead of needles to infuse the vials with sterile water,
because the spikes have a larger gauge and can deliver higher vol-
umes of fluid more quickly.
Always be prepared
When the spine patient exhibited symptoms of MH, everyone on our
staff responded perfectly and followed our response plan exactly as
we had hoped. The team was extremely proud of their success and
was inspired to refine our protocols even more for the next emer-
gency. We're ready to save a life. Are you?
OSM
3 4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 1 9
Ms. Hershberger (dominiquehershberger775@hotmail.com) is a charge nurse
at Lutheran Medical Center in Wheat Ridge, Colo.
