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of surprise keeps them honest, hones their on-the-spot critical think- ing skills and lets managers assess how they'd respond to an actual emergency. The clinical team recently ran through a drill for malignant hyperther- mia, "a rare event, and one we'll hopefully never see, but it's the rarity that makes it so important to prepare for," says Ms. Smith. The MH drill convinced the team that seemingly small changes would improve their response protocols. They attached IV poles to MH carts (and code carts) so fluids could be more readily prepared. They also moved some of the equipment needed to mix the dantrolene into the same drawer to make the reconstituting process more seamless. Importantly, the staff learned to look for the red flags of MH. "Treating the condition when the early signs are noticed turns a life-threatening emergency into a manageable crisis," says Ms. Smith. "The outcome is much more dire if you recog- nize MH after the body's core tempera- ture begins to rise." Her team also learned that it's not enough to pull the MH cart to the patient's bedside. Your staff might review the con- tents of the cart each month to ensure items are stocked and up to date, but they might not remember where 4 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • S E P T E M B E R 2 0 1 6 *from the date of manufacture † or until solution is clear Important Safety Information The use of Revonto in the management of malignant hyperthermia crisis is not a substitute for previously known supportive measures. These measures must be individualized, but it will usually be necessary to discontinue the suspect triggering agents, attend to increased oxygen requirements, manage the metabolic acidosis, institute cooling when necessary, monitor urinary output, and monitor for electrolyte imbalance. Patients who receive i.v. dantrolene sodium preoperatively should have vital signs monitored. If patients judged malignant hype If patients judged malignant hyperthermia susceptible are administered dantrolene sodium preoperatively, anesthetic preparation must still follow a standard malignant hyperthermia susceptible regimen, including the avoidance of known triggering agents. Monitoring for early clinical and metabolic signs of malignant hyperthermia is indicated because attenuation of malignant hyperthermia, rather than prevention, is possible. Despite initial satisfacto Despite initial satisfactory response to i.v. dantrolene there have been reports of fatality, which involve patients who could not be weaned from dantrolene after initial treatment. The administration of i.v. dantrolene is associated with loss of grip strength and weakness in the legs, as well as drowsiness and dizziness. There have been reports of thrombophlebitis following administration of intravenous dantrolene. Tissue necrosis secondary to extravasation has been reported. Injection site reactions (pain, erythema, swelling), commonly due to extravasation, have been reported. Fatal and non-fatal liver disorders of an idiosyncratic or hypersensitivity type may occur with dantrolene sodium therap type may occur with dantrolene sodium therapy. To see the full prescribing information visit www.revonto.com. © 2016 US WorldMeds, LLC. Revonto is a registered trademark of US WorldMeds, LLC. 36 month shelf life* Ready to administer in 20 seconds † Visit www.revonto.com or call (877) 411-USWM (8796) to learn more about Revonto and to see the full Prescribing Information. REV-P81-1215 ® Are You Prepared for a CRISIS? Awards Issue