third placed a Foley catheter through which they ran cold saline.
Somebody took blood and urine samples, while someone else record-
ed what was happening.
Mixing dantrolene, perhaps the most important step in an MH
episode, was a 2-person job. Dantrolene takes time and very vigorous
shaking to liquefy. It simply doesn't dissolve quickly in sterile water,
says Dr. Thornhill. "You really need to shake it well — do whatever
you can to get it to dissolve," she says. "That's something I think is
really important to practice, so you're not wondering if you're doing
something wrong and you know how much time to allot."
The surgeon had a job as well. He contacted the hospital that was
going to receive the MH patient and gave the ER a full report. The ER
used a cold blower to cool the room before the patient arrived. Dr.
Thornhill and the head nurse rode with the patient in the ambulance.
They took along a bucket of ice for the ambulance ride to keep the
patient cool. They also brought with them an emergency transfer
tackle box stocked with such items as vials of dantrolene, propofol, a
muscle relaxant, an endotracheal tube, tape and an oral airway.
"The chances of a paramedic having seen MH in his career is proba-
bly very low," says Dr. Thornhill. "You can almost be assured they
don't stock dantrolene in the ambulance, let alone know how to give
it."
The patient's temperature returned to normal shortly after he arrived
in the ER. Dr. Thornhill credits the mock drills. "It's all about mock
codes and practicing all those different scenarios so that you're com-
fortable in an emergency," she says.
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