March is malignant hyperthermia awareness and training month and at OctariusRx, we recognize and support the cause.
Malignant hyperthermia (MH) is a rare, inherited disorder that can affect patients who are receiving anesthesia for surgery or other procedures. Being prepared is paramount for patient safety. Is your facility ready? Do you have a plan in place? Do you conduct routine mock drills and provide staff education?
Ensuring patient safety is at the top of our priority list and requires preparation. Being prepared, requires ongoing effort and routine assessments, such as mock drills. Not all facilities face the risk of MH, but for facilities who use MH-triggering agents such as inhaled general anesthetics or succinylcholine, the danger is real and must be taken seriously.
If your facility is using MH triggering agents, you should know what steps to take and what medications must be included in the MH cart if a crisis occurs. How do you prepare? Update your training and assessments frequently so that your staff can quickly recognize, diagnose and treat the disorder. Additionally, keeping an appropriate supply of medications and equipment is a must. To ensure you are fully prepared, you can work with your pharmacy consultant (View Our Services if you don’t yet have a Consultant Pharmacist).
Responding to a MH event requires quick and efficient action: it truly is a situation that requires ‘all-hands-on-deck’.
According to the Malignant Hyperthermia Association of the United States (MHAUS), the following four steps are recommended for handling MH events:
- Notify the surgeon to halt the procedure as soon as possible and discontinue any triggering agents.
- Retrieve the dantrolene/MH cart and call 911.
- Hyperventilate the patient with 100% oxygen at flows of 10L/minute.
- Give IV dantrolene at 2.5 mg/kg rapidly.
For additional details, see “Emergency Treatment for An Acute MH Event”.
What medications should be in the MH cart?
According to MHAUS, the cart must include the following:
- Dantrolene: either 36 vials of Dantrium/Revonto or 3 vials of Ryanodex.
- Sterile water for injection (without preservative):
If you’re stocking Dantrium/Revonto, each vial requires 60mL of sterile water for reconstitution. Each vial of Ryanodex only requires 5mL of sterile water. - Sodium bicarbonate: (8.4%) – 50 mL x 4.
- Dextrose: 50% – 50 mL vials x 2.
- Calcium chloride: (10%) – 10 mL vial x 2.
- Lidocaine for injection: (2%) – 100 mg/5 mL or 100 mg/10 mL in preloaded syringes x 3. Amiodarone is also acceptable.
The following two items, although still part of the cart, must be kept in a refrigerator.
- Regular insulin – 100 units/mL x 1.
- Refrigerated saline solution – A minimum of 3,000 mL for IV cooling.
View the complete list of MHAUS recommended MH cart contents.
Still have questions? Contact us for a free consultation today: we can help you set up a system to ensure compliance with licensing and accrediting agencies such as the Centers for Medicare and Medicaid Services (CMS), Accreditation Association for Ambulatory Health Care (AAAHC), The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) and The Joint Commission (TJC). Not only will you be compliant, but your team will also be ready, and your patients will be safer.
The Consultant Pharmacists at OctariusRx provide guidance on safe medication management, survey readiness and cost savings to ambulatory healthcare facilities/surgery centers, senior care facilities and pharmacies. We also help individual patients optimize their medications to improve their quality of life and save money. Contact us for assistance.
