Page 25
E M E R G E N C Y
R E S P O N S E
knowledge of what MH is and an appreciation of how difficult it is to treat it quickly and effectively.
We also know that saving a patient's life when MH hits demands a true team effort from literally every available staffer who can lend a hand. There are many critical assignments that need to be carried out, so assign specific roles to specific members of the team.
Every facility has its own response protocols, but this is what works for us. The anesthesia provider identifies the complication's onset and immediately asks the circulator to call a "Code Blue" and bring the MH kit and crash cart into the room. We have 1 MH kit to serve our 9 ORs. It's stored next to the code cart and checked daily to ensure the supplies are intact and current. The kit contains 36 vials of dantrolene, which is enough to administer 2 rounds of boluses for a patient of average weight; syringes with large-bore needles; 1,000L bags of sterile saline; IV tubing and stopcocks.
The nurse at the main OR desk pages all available nurses and patient care assistants to join the response team. She also calls the MHAUS hotline (800-MH-HYPER) and patches the call through to the OR if the additional support is needed. MHAUS is a wonderful organization. The experts who man the hotline can guide your surgical team through the entire emergency, advising them what to look for and how to react after each step of the intervention is completed.
The extra hands who respond are needed to help reconstitute the dantrolene, the only specific treatment for MH. During an attack, says MHAUS, calcium levels in muscles increase, causing a corresponding increase in muscle metabolism, which causes the muscles to contract. Dantrolene directly interferes with the contraction by decreasing calcium levels in muscle cells.
Each vial of dantrolene has to be reconstituted with 60cc of sterile, preservative-free saline solution, and it takes a total team effort to get it done quickly and effectively. We hook a 1,000L bag of sterile water to an IV tube attached to a stopcock through which we use a 60cc syringe to draw the needed amount as efficiently as possible. One nurse draws the sterile saline and passes it to a second nurse, who injects it into a dantrolene vial. She then passes the vial to the next
