Emergencies, Complications, and Resuscitation
What the exam tests
Emergencies, Complications, and Resuscitation tests recognition and first-line treatment of malignant hyperthermia, local anesthetic systemic toxicity, anaphylaxis, laryngospasm, aspiration, and cardiac arrest.
Core rules and concepts
- Malignant hyperthermia: stop volatile agents and succinylcholine, hyperventilate with 100% oxygen, call for help, give dantrolene 2.5 mg/kg IV, cool, treat hyperkalemia and arrhythmias.
- Local anesthetic systemic toxicity: stop injection, secure airway, give 20% lipid emulsion 1.5 mL/kg, then infusion 0.25 mL/kg/min; repeat boluses as needed.
- Anaphylaxis: epinephrine 1 mg IV every 3–5 min in arrest; in non-arrest, titrate smaller IV doses or IM 0.3–0.5 mg, plus fluids and oxygen.
- Laryngospasm: remove stimulus, apply continuous positive airway pressure with 100% oxygen, deepen anesthesia; use small-dose succinylcholine if severe.
- Cardiac arrest: start CPR, follow ACLS, and identify reversible causes.
Worked example
An 80-kg patient develops masseter rigidity, rising end-tidal CO2, and fever after sevoflurane and succinylcholine. Reasoning: treat as malignant hyperthermia. Dantrolene dose = 2.5 mg/kg × 80 kg = 200 mg. With 20-mg vials, give 10 vials, repeat until stable, and continue monitoring for recrudescence.
Traps
Do not continue the triggering agent while waiting for dantrolene. Do not delay lipid emulsion in severe LAST. Do not give large IV epinephrine boluses to a non-arrest anaphylaxis patient. Do not confuse shivering with malignant hyperthermia. Do not forget to call for additional help early.