Emergency Situations
Malignant hyperthermia
Triggers are volatile anesthetics and succinylcholine. Earliest and most reliable signs are unexplained tachycardia, tachypnea, and rising end-tidal carbon dioxide despite adequate ventilation; masseter or generalized muscle rigidity, acidosis, and hyperkalemia follow. Hyperthermia is a late sign, and waiting for it costs lives. Response: discontinue triggering agents, call for help, hyperventilate with 100 percent oxygen at high flow, give dantrolene 2.5 mg/kg IV repeated until symptoms are controlled (up to 10 mg/kg), cool actively, treat acidosis and hyperkalemia, monitor urine output, and transfer to intensive care. Calcium channel blockers are avoided in patients receiving dantrolene.
Other high-stakes events
Anaphylaxis: stop the trigger, secure the airway, give epinephrine, fluids, and vasopressors. Local anesthetic systemic toxicity: stop injection, support the airway, and give 20 percent lipid emulsion. Massive hemorrhage activates a massive transfusion protocol with balanced component therapy and warming. Cardiac arrest follows ACLS with attention to the restricted workspace and open surgical field.
Surgical fire
The fire triad is fuel, oxidizer, and ignition source. Prevention includes allowing alcohol-based preps to dry fully, avoiding oxygen accumulation under drapes, holstering electrosurgery when not in use, and keeping the field moist near ignition sources. Response: stop the gas flow, remove burning material, smother the fire, cool with saline, then evacuate or extinguish per the facility's RACE and PASS protocols.
Rule of thumb
Treat the earliest physiologic signal, not the classic late finding. Unexplained tachycardia plus rising carbon dioxide is malignant hyperthermia until proven otherwise.