2 0 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E J U LY 2 0 1 6
while planning to re-administer it after. Not surprisingly, the test and subse-
quent simulations revealed numerous areas for improvement, not just for
those who took part, but also for those of us who designed them.
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Understand the warning signs
One of the deficiencies we found among staff members who thought
they knew a fair amount about MH was the misconception that high tem-
perature is one of the early signs. In reality, it's usually one of the later signs, fol-
lowing an increase in end-tidal carbon dioxide, rapid heartbeat, muscle rigidity
and rapid breathing. And in our research, we learned that early recognition of
symptoms is a huge factor in improving survival.
We also talked about complacency, about never letting our guard down. It's
important to understand that, on average, patients who experience MH have
had 6 uneventful anesthetic events before that initial crisis is triggered.
So we focused first on recognition and on what to do before the MH cart or
toolbox arrives — like hyperventilating the patient, calling the Malignant
Hyperthermia Association of the United States (MHAUS) hotline (800-644-9737),
putting out a call for as many hands as possible to be available to provide help,
packing the patient in ice, and discontinuing volatile anesthetic agents and suc-
cinylcholine.
Most simulations are done in the OR, but MH's warning signs might not
manifest until hours after a procedure. In fact, the crisis that Ms. Albert faced
started just as the procedure was being finished in the OR. The team was so
close to the end that they quickly finished and transferred the patient to the
recovery room, where they knew they'd have more help. Her experience made
us realize that our education and initiative also needed to go beyond the pro-
cedure area to the PACU.
