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nurse in line, who rolls it in her hands to dissolve the saline. Once the dantrolene-saline solution is fully mixed, she passes the vial to the final person in line, who draws the reconstituted drug into a syringe and hands it to the anesthesia provider for administration.
The anesthesia provider already knows the patient's weight, so he informs the mix team how much dantrolene is needed for the initial dose (see "Calculate the Initial Dose In 3 Easy Steps"). By the time the team gets the first round mixed and ready for administration, they start preparing another round, because the initial bolus is repeated every 5 minutes until a maximum dose is reached.
Other nurses man the code cart, place a foley catheter in the patient, run for bagged ice to place on the patient and make arrangements to transfer the patient to an acute care setting with adequate support staff for immediate observation in an intensive care unit.
Rehearsed responses
Practice your MH response at least annually at mandatory education sessions for the OR nurses, all your anesthesia providers, and the pre- and post-op nursing staff. Divide your staff into small groups for question and answer sessions about how to manage an MH crisis. Have members of each team assume roles — nurse, anesthesia provider, circulator — and give them scenarios to discuss. What would they do during a real emergency?
Throw a "mixing party" with your expired dantrolene. It's a valuable exercise for all members of your team, but particularly important for nurses who have never reconstituted the drug. They need the hands-on experience to understand how truly challenging the process is, and why so many people are needed to quickly prepare the medication for administration.
Ms. Garner (mgarner@uabmc.edu) is the director of regulatory affairs, safety, education, infection control and employee health at Callahan Eye Hospital in Birmingham,
Ala.
