Emergency preparedness case study: malignant hyperthermia.

The second of this 2012 Case Study series addresses a situation that is uncommon in the surgical setting. Without proper recognition and prompt treatment, the mortality rate can be as high as 80% (Christiansen & Collins, 2004; Larach, Gronert, Allen, Brandom, & Lehman, 2010). With prompt recognition and intervention when this emergency does arise, the mortality rate has been reduced to 5% ((Rosenberg, Sambuughin, & Dirksen, 2010). Malignant hyperthermia (MH) is an inherited syndrome that affects 1 of 50,000 adults and 1 of 15,000 pediatric patients undergoing anesthetic procedures (Christiansen & Collins, 2004; Rosenberg et al., 2010). In this article, the reader is exposed to a case of MH and is asked a series of questions related to risk assessment, signs and symptoms, and nursing responsibilities.

Nursing Interventions of Intraoperative Malignant Hyperthermia in Patients With Scoliosis: A Report of 3 Cases.

INTRODUCTION: The report summarizes the intraoperative rescue and nursing intervention of malignant hyperthermia (MH) in the correction surgery for 3 patients with spinal deformity. Although rare, MH may occur in up to 1 of 5000 cases. INTERVENTION: The key points of nursing care include preoperative MH risk assessment, MH early warning, cessation of anesthetic, use of a validated scoring system, and initiation of cooling measures. CONCLUSION: Prompt nursing recognition and team-fcoused interventions provided successful rescue of 3 patients with MH.

Effect of Norepinephrine on Intracellular Ca2+ Levels in Malignant Hyperthermia-Susceptible B Cells: Pilot Study in the Search for a New Diagnostic Test for Malignant Hyperthermia.

Malignant hyperthermia (MH) crises may induce morbidity or death in MH-susceptible (MHS) individuals. The only sensitive method of determining susceptibility is the caffeine-halothane contracture test, requiring muscle biopsy. Early research on MH demonstrated an abnormal response to catecholamines in MHS individuals. The purpose of this study was to determine whether MHS B lymphocytes would demonstrate an increased sensitivity to norepinephrine as indicated by an adrenergic augmentation of intracellular calcium ion (Ca2+) accumulation, to possibly develop a less invasive laboratory assay for determining MH susceptibility. The fluorescent Ca2+ indicator dye fura-2 acetoxymethyl was used to identify Ca2+ flux within Epstein-Barr virus- immortalized MH-negative (MHN) and MHS B cells exposed to the RyR1 agonist 4-chloro-m-cresol (4-CmC) before and after administration of 1 µM of norepinephrine. In the presence of 4-CmC and norepinephrine, the area under the curve dose responses were significantly elevated in MHS B cells compared with MHN B cells (F[1,10] = 27.37; P < .01). Epstein-Barr virus-immortalized B cells from MHS humans displayed an increased sensitivity to norepinephrine compared with those from MHN individuals. These data suggest that an abnormal response to exogenous norepinephrine could potentially be used to develop a diagnostic laboratory assay to determine MH susceptibility.

Malignant hyperthermia.

Malignant hyperthermia, also known as malignant hyperpyrexia, is a pharmacogenetic condition which can develop during general anaesthesia and can be fatal. The author suggests that more awareness of the condition is needed by ward-based nurses who are involved with patients undergoing surgery. The article describes the management of the condition, the nursing care and the screening available for susceptible patients.

Integrating Simulations Into Perioperative Education for Undergraduate Nursing Students.

Incorporating high-fidelity simulations into an undergraduate nursing program's perioperative elective course capitalizes on students' active learning. Simulations allow students the opportunity to assess and participate in clinical scenarios, apply standards, and demonstrate correct nursing actions without compromising patient safety. Incorporating a high-risk, low-volume malignant hyperthermia simulation experience into the undergraduate nursing curriculum emphasizes active learning and provides an opportunity for students to experience an uncommon emergency perioperative event. A high-fidelity malignant hyperthermia simulation links a scenario with course content, incorporates didactic information from previous courses, and emphasizes the importance of debriefing.

MALIGNANT HYPERTHERMIA--AN UPDATE FOR PERIOPERATIVE NURSES.

This article is a summary of the "Updates on Malignant Hyperthermia" presentation given at the 2015 ORNAC National Conference in Edmonton. It presents the facts known about malignant hyperthermia (MH) including definition, anesthetic and non-anesthetic triggers for MH, signs and symptoms, and treatment of MH. It also discusses the care of an MH susceptible patient while undergoing an elective surgery.

Using a Vulnerability Theoretical Model to Assess the Malignant Hyperthermia Susceptible Population: Implications for Advanced Practice Emergency Nurses.

Malignant hyperthermia (MH) is a high-risk, low-occurrence medical emergency with symptoms that include a severe increased rate of metabolic activity and rigid skeletal muscles. Clinicians should be knowledgeable and prepared for an MH event because it can occur in areas outside the operating room and without anesthetic triggers. Patients who have this rare genetic condition may come to the emergency department (ED) presenting with symptoms of heat stroke. However, the incidence of suspected MH in the ED or other critical care areas is not easily quantifiable because clinicians may not report cases to a centralized registry. The purpose of this article is to describe the MH-susceptible vulnerable population, to apply a vulnerability theoretical model to assess patients and families, to identify strategies for health promotion to reduce vulnerability, and to discuss how advanced practice nurses who specialize in emergency care can help decrease the vulnerability of MH-susceptible patients and families. By using a vulnerability model to assess the MH-susceptible population, nurses can effectively sort out strategies to prevent poor patient outcomes related to MH and promote health for this high-risk population. Measuring accurate core temperatures, applying effective cooling methods, and administering dantrolene are key concepts in caring for a patient who is experiencing an MH event. Advanced practice emergency nurses can participate in reducing vulnerability for this population by applying the Emergency Nurses Association Clinical Nurse Specialist competencies to MH-related vulnerabilities. Enhancing preparedness, evaluating and coordinating education programs, advocating for report submissions to the North American Malignant Hyperthermia Registry, and assessing opportunities for community collaboration are among the strategies discussed for reducing vulnerability for the MH-susceptible population.

La enfermería de quirófano ante la Hipertermia Maligna. ¿Estamos preparados? / Surgical Nurse on Malignant Hyperthermia. Are we prepared?

OBJETIVO PRINCIPAL: Evaluar el conocimiento de la Hipertermia Maligna (HM) entre los profesionales de Enfermería de quirófano. METODOLOGÍA: Estudio descriptivo transversal con 169 profesionales de Enfermería de quirófano. RESULTADOS PRINCIPALES: La puntuación total de los cuestionarios alcanzó un promedio de 4,8 (±2,18) puntos sobre 10 totales. Disponer de un protocolo para la asistencia de episodios de HM, se relacionó de forma significativa con un conocimiento adecuado. CONCLUSIÓN PRINCIPAL: Los profesionales de Enfermería de quirófano presentan unos inadecuados niveles de conocimiento sobre la HM y su manejo. Es necesaria una mejora en la preparación de las enfermeras para atender a un paciente en crisis de HM

MAIN OBJECTIVE: Assessing knowledge levels of the surgical nurses regarding Malignant Hyperthermia (MH) and its management. METHODOLOGY: Cross-sectional descriptive study among 169 surgical nurses. MAIN RESULTS: The total score of the questionnaires reached an average of 4.8 (± 2.18) points out of 10 total. Having an standart operating procedute for the assistance of MH episodes was significantly related to adequate knowledge. MAIN CONCLUSION: Surgical nurses have inadequate levels on managing MH and delivering inmediate care. It is necessary to provide specific trainning on MH for surgical nurses to prepare them to safely assist patients suffering MH crisis

Malignant hyperthermia.

Malignant hyperthermia is a pharmacogenetic disease of skeletal muscle characterized by hypermetabolism that occurs on exposure to a triggering agent or agents. The most common agents are halogenated inhalational anesthetics and succinylcholine, a depolarizing muscle relaxant. Patients who experience malignant hyperthermia are generally transferred to the ICU for ongoing treatment and monitoring for secondary complications of the disorder. Critical care practitioners must be both knowledgeable and competent to prevent and treat perioperative episodes of malignant hyperthermia. A thorough preoperative interview should be done to determine risk factors and susceptible patients. This article provides critical care nurses with sound information on the pathophysiology of malignant hyperthermia, the ability to assess the disease properly and treat the patient both before and after the crisis, and the ability to provide support and teaching to patients and patients' families to prevent the recurrence of malignant hyperthermia.

Malignant hyperthermia: nursing implications.

This paper presents the pathophysiology, clinical symptoms, and a standard of care for the patient with MH. The information provided will assist the nurse in interpreting patient and technologic data to identify recurring episodes of MH, and prevent the negative outcomes associated with this syndrome.

Malignant hyperthermia.

Malignant hyperthermia (MH) is an acute syndrome that occurs in genetically susceptible persons who have been exposed to certain anesthetic agents. It can also be induced by catecholamines activated by stress. One in 200 people is at risk for developing malignant hyperthermia. The mortality rate may be as high as 15%. A thorough history obtained before surgery is of extreme importance to prevent an MH crisis and in the management of those susceptible to the disorder. If MH is suspected a diagnosis, which can be confirmed by muscle biopsy, should be ruled out before surgery.

Malignant hyperthermia.

Although MH is a rare disease, occurring 1 in 7000 to 14,000 anesthetics in children and one in 50,000 to 200,000 anesthetics in adults, the critical care nurses must possess knowledge of its causes and treatment. MH can be potentially fatal. With aggressive intervention, both morbidity and mortality will be reduced.

Malignant hyperthermia. Update 2000.

MH is a life-threatening crisis that can be controlled if promptly recognized and appropriately treated. Identification of patients at risk for MH is an ongoing crusade. Preparedness with needed supplies available at hand facilitates optimal treatment. All perioperative personnel should remain current in their knowledge of MH management and treatment to ensure the best possible outcome for their patients.

Malignant hyperthermia.

Malignant hyperthermia (MH) is a medical emergency that all perioperative nurses should be prepared to handle. Patients with the inherited MH trait have a rare skeletal muscle disease that causes them to develop life-threatening hyperthermia (ie, body temperatures of 43.3 degrees C [110.0 degrees F] or higher) at the time MH-triggering agents are administered to induce general anesthesia or shortly thereafter. The incidence of MH episodes is reported to be 1 in every 12,000 pediatric anesthetic procedures and 1 in every 40,000 adult anesthetic procedures. The MH syndrome also is characterized by continuous skeletal muscle rigidity, hypermetabolism, hypercapnia, tachypnea, and tachycardia that result in cardiac arrest and death if left untreated. Perioperative staff members' knowledge of MH, the care of MH-susceptible patients, and adequate preparation for MH crises are the cornerstones of successful patient outcomes to this life-threatening syndrome.

Genetics in the OR--implications for perioperative nursing practice.

New developments in deoxyribonucleic acid (DNA) technology are increasing understanding of the role of genetics in health and disease. This kind of health information requires that perioperative nurses develop new skills and roles that will enhance the quality of genetic health care they provide to patients, particularly with regard to managing genetic information. Perioperative nurses expand their scope of practice to incorporate a genetic focus into health assessment, patient education, and patient support as they assimilate new genetic information into their daily lives. Perioperative nurses familiar with genetic counseling services--and how and when to refer patients for such services--will ensure that all patients have access to the most current and appropriate genetic information with which to make informed health choices.

Update for nurse anesthetists. Part 6. Full-body patient simulation technology: gaining experience using a malignant hyperthermia model.

Simulation technology is extremely useful for training workers in a variety of industries. Simulation concepts have been developed and refined in full-body patient simulators. Contemporary full-body patient simulators can be used to teach the essential concepts of many healthcare professions, and they offer practice dealing with critical events, concentrating on the thought and decision-making processes related to favorable patient outcomes. Full-body patient simulators provide practitioners the opportunity to manage realistic and advanced physical findings in a variety of areas and are capable of responding to a large number of pharmacologic agents and a host of clinical interventions. The ability to combine high-fidelity educational tools with both classroom lecture and clinical experience provides nurse anesthetists the opportunity for a unique experience in a highly controlled and safe environment. Numerous technological and educational advantages and the chance for hands-on assessment and treatment of some of anesthesia's rarest and most life-threatening events provide a one-of-a-kind educational session for CRNAs.

Malignant hyperthermia: not just an operating room emergency.

While usually occurring as an operating room emergency, malignant hyperthermia can appear postoperatively on a medical-surgical unit. If unrecognized and/or untreated, malignant hyperthermia can be fatal. Medical-surgical nurses should be skilled in identifying the pathophysiology, signs/symptoms, and treatment of malignant hyperthermia.