Malignant Hyperthermia Flashcards Preview

AP: Cumulative > Malignant Hyperthermia > Flashcards

Flashcards in Malignant Hyperthermia Deck (37):
1

what is the primary ion associated with MH?

calcium

2

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

hypermetabolism

3

what are the triggering agents for MH?

succinylcholine
volatile agents

4

what happens to O2 consumption during MH?

increases 3-5x normal

5

what is the predominant sign of MH?

drastic sudden increase in EtCO2

6

MH is often associated with what other type of disorders?

muscle disorders

7

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

Stop triggering agent

8

when can MH present?

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

9

what are the early signs of MH?

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

10

where does dantrolene work?

at the muscle

11

later signs of MH include...

worsening of other symptoms
increase in temp
hemodynamic instability

12

is muscle rigidity always present with MH?

NO

13

T or F: MH occurs only during induction

FALSE

14

T or F: Once treated, MH will not reoccur

FALSE

15

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

Hyperkalemia --> V fib

16

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

pulmonary edema
coagulopathy
acid/base abnormalities, electrolyte imbalance

17

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

multi-organ failure, brain damage
renal decompensation

18

"chipmunk cheeks" are associated with what?

MMR-Masseter Muscle Rigidity

19

how common is masseter muscle rigidity?

rare (0.008%)

20

what CPK is strongly associated with MH?

CPK >20,000

21

list four diseases associated with MH

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

22

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

-Exertional heat stroke
-Exercise induced rhabdomyolysis
-Carnitine palmitoyl transferase deficiency
-Duchenne muscular dystrophy, Becker muscular dystrophy

23

when is succinylcholine indicated?

difficult airway
full stomach

24

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.

acute hyperkalemia

25

what is the normal cause for an increase in temperature?

iatrogenic overheating

26

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

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

27

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

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

28

what are the first steps of treatment for MH?

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

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

2.5mg/kg
20 mg bottle (powder)

30

what should you not give in conjunction with dantrolene?

Calcium Channel blockers (can cause cardiac arrest)

31

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

Hot not normal....don't want to overshoot

32

how long should dantrolene be given?

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

33

how long should MH patients stay in ICU?

24-48 hours

34

what is the gold-standard in MH testing?

Halothane-Caffeine Contracture Test

35

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

< 4 y/o (20kg)
< 3 mos. from the event

36

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

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

37

worse out comes are associated with what two factors?

Muscle build and DIC (disseminated intravascular coagulopathy)