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AP II > Malignant Hyperthermia > Flashcards

Malignant Hyperthermia Flashcards

1
Q

what is the primary ion associated with MH?

A

calcium

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2
Q

patients with MH exhibit significant hyper- or hypo-metabolism?

A

hypermetabolism

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3
Q

what are the triggering agents for MH?

A

succinylcholine

volatile agents

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4
Q

what happens to O2 consumption during MH?

A

increases 3-5x normal

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5
Q

what is the predominant sign of MH?

A

drastic sudden increase in EtCO2

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6
Q

MH is often associated with what other type of disorders?

A

muscle disorders

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7
Q

what is the first step of treatment when MH is suspected?

A

Stop triggering agent

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8
Q

when can MH present?

A

Explosive onset during induction of anesthesia
Insidious onset during maintenance of anesthesia
Insidious onset postoperatively

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9
Q

what are the early signs of MH?

A 
increase CO2
increase HR
resp/metabolic acidosis
venous desaturation
electrolyte abn
Masseter Muscle Rigidity
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10
Q

where does dantrolene work?

A

at the muscle

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11
Q

later signs of MH include…

A

worsening of other symptoms
increase in temp
hemodynamic instability

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12
Q

is muscle rigidity always present with MH?

A

NO

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13
Q

T or F: MH occurs only during induction

A

FALSE

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14
Q

T or F: Once treated, MH will not reoccur

A

FALSE

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15
Q

what is the normal cause of death for MH patients in the first few hours?

A

Hyperkalemia –> V fib

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16
Q

what is the normal cause of death for MH patients after several hours?

A

pulmonary edema
coagulopathy
acid/base abnormalities, electrolyte imbalance

17
Q

what is a common cause of death for MH patients days after original symptoms?

A

multi-organ failure, brain damage

renal decompensation

18
Q

“chipmunk cheeks” are associated with what?

A

MMR-Masseter Muscle Rigidity

19
Q

how common is masseter muscle rigidity?

A

rare (0.008%)

20
Q

what CPK is strongly associated with MH?

A

CPK >20,000

21
Q

list four diseases associated with MH

A

Central Core Disease
King-Denborough Syndrome
Hypokalemic periodic paralysis
Multiminicore Disease

22
Q

what are some other conditions that have possible connections to MH?

A
  • Exertional heat stroke
  • Exercise induced rhabdomyolysis
  • Carnitine palmitoyl transferase deficiency
  • Duchenne muscular dystrophy, Becker muscular dystrophy
23
Q

when is succinylcholine indicated?

A

difficult airway

full stomach

24
Q

Children less than 9 years of age who experience a sudden cardiac arrest after succinylcholine, in the absence of hypoxemia, should be treated for ________ first.

A

acute hyperkalemia

25
Q

what is the normal cause for an increase in temperature?

A

iatrogenic overheating

26
Q

what are some differential diagnoses for MH associated with Tachycardia (with/without fever and no rigidity)

A

hypoxia, light anesthesia, iatrogenic overheating, tourniquet, thyrotoxicosis, sepsis, pheochromocytoma, transfusion reaction, osteogenesis imperfecta, anti-cholinergic syndrome

27
Q

what are some differential diagnoses for MH associated with Tachycardia, fever and muscle rigidity?

A 
NMS
hypoxic encephalopathy
ionic contrast agents in CSF
amphetamine toxicity
cocaine toxicity
ETOH withdrawal
28
Q

what are the first steps of treatment for MH?

A

STOP all volatile agents and Succinylcholine
CALL FOR ASSISTANCE!
HYPERVENTILATE with 100% O2, flow > 10 L/min (circle system and absorbent need not be changed)
Give Dantrolene

29
Q

what is the normal dose for dantrolene and how is it provided?

A

2.5mg/kg

20 mg bottle (powder)

30
Q

what should you not give in conjunction with dantrolene?

A

Calcium Channel blockers (can cause cardiac arrest)

31
Q

what is the end goal for temperature for a MH patient?

A

Hot not normal….don’t want to overshoot

32
Q

how long should dantrolene be given?

A

continue Dantrolene (1 mg/kg IV every 6 hours) x 24-36 hours

33
Q

how long should MH patients stay in ICU?

A

24-48 hours

34
Q

what is the gold-standard in MH testing?

A

Halothane-Caffeine Contracture Test

35
Q

what are the contraindications for the Halothane-Caffeine Contracture Test?

A

< 4 y/o (20kg)

< 3 mos. from the event

36
Q

what equipment concerns must be taken into consideration for patients at risk for MH?

A 
"clean" machine
- no vaporizers
-flush system with fresh gas
-fresh circuits
MH cart near OR
Standard monitors available
37
Q

worse out comes are associated with what two factors?

A

Muscle build and DIC (disseminated intravascular coagulopathy)

AP II (32 decks)

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