Emergency Preparedness and Crisis Response
Malignant hyperthermia is the archetype
MH presents with a rising ETCO2 unresponsive to increased ventilation, tachycardia, rigidity, and acidosis; hyperthermia is a late sign. Actions: stop volatile agents and succinylcholine, switch to a clean circuit with 100% oxygen at high flow (≥10 L/min), give dantrolene 2.5 mg/kg IV and repeat until controlled, cool appropriately, treat hyperkalemia and acidosis, monitor urine output, and call for help and the MHAUS hotline. Know where the MH cart lives and that 36 vials (720 mg) of dantrolene are conventionally stocked for the initial adult response.
Other crises with stock responses
Anaphylaxis: stop the trigger, epinephrine, fluids, oxygen. LAST: stop injection, airway and oxygenation, benzodiazepines for seizures, 20% lipid emulsion 1.5 mL/kg then 0.25 mL/kg/min. Laryngospasm: 100% oxygen with CPAP, deepen anesthesia, lidocaine 1–1.5 mg/kg IV, succinylcholine 0.1–1 mg/kg if saturation falls. Venous air embolism: left lateral head-down, 100% oxygen, aspirate from a central catheter. Aspiration: suction, oxygen, consider bronchoscopy.
Rule of thumb: in any crisis, work Oxygen–Airway–Breathing–Circulation, then drug, and use closed-loop communication with named roles so no task is assumed.
Trap: waiting for hyperthermia before treating MH, and forgetting that mock drills and cart checks are what make the response fast.