Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
18 Cards in this Set
- Front
- Back
AP II EXAM 2 MALIGNANT HYPERTHERMIA
|
AP II EXAM 2 MALIGNANT HYPERTHERMIA
|
|
What are the components of MH?
|
1. pharmacogenetic disorder
2. triggered by pharmacogentic agents 3. abnormal handling of intracellular Ca++ 4. hypermetabolism 5. death if untreated |
|
Hot line
|
Reports indicated mortality from MH
|
|
What are the triggering agents?
|
1. succinylcholine
2. volatile inhalation agents (except nitrous) 3. extreme exercise (very rare) |
|
Clinical presentation
|
1. explosion onset during INDUCTION of anesthesia
2. insidious onset during MAINTENANCE of anesthesia 3. insidious onset postop |
|
Hyperthermia appears during what stage of MH?
|
Late stage
|
|
What factors increase with MH?
|
1. CO2
2. HR/ dysrhythmias 3. resp/metabolic acidosis |
|
Current concepts on the presence of clinical manifestations of MH?
|
1. muscle rigidity may or may not be present.
2. early sign of increased end tidal CO2. 3. Temp. is a LATE sign 4. MH may occur at any point during anesthesia, or at emergence. 5. recrudescence despite Tx |
|
What are the signs of MH?
|
1. inc. CO2 production
2. rhabdomyolysis 3. marked temp. elevation 4. muscle rigidity |
|
Death from MH is usually due to?
|
First few hours:
1. hyperkalemia 2. V-Fib Several hours 1. pulmonay edema 2. coagulopathy 3. acid/base imbalance Days later 1. multi-organ failure, brain damage 2. renal decompensation |
|
If pt. gets masseter muscle rigidity (MMR), then...
|
1. stop triggering agent
2. continue non-triggering agents 3. adm. DANTROLENE 4. check CPK/electrolytes 5. check urine/serum myoglobin 6. inform pt and family |
|
Children under 9 y.o that have a cardiac arrest after Sux, in the absence of hypxemia, should be treated with what first?
|
Should be treated for acute hyperkalemia first.
|
|
What is the acute phase therapy for MH?
|
1. STOP all volatile agent and Succinylcholine.
2. CALL FOR ASSISTANCE 3. HYPERVENTILATE with 100% O2 with flow > 10L/min 4. give DANTROLENE 5. Tx arrythmias 6. Tx hyperthermia 7. |
|
Dantrolene dose
|
For Tx of MH IMMEDIATE therapy.
2.5 mg/kg 20mg bottle |
|
Side effects of dantrolene
|
1. cardiac arrest with Ca++ channel blockers
2. thrombophlebitis 3. synergistic action with neuromuscular blockade |
|
Post Acute Phase Therapy
|
1. continue dantrolene
2. continuously monitor Temp 3. watch for signs of recrudescense, myoglobinurea, renal failure, DIC. 4. observe in ICU |
|
Post Acute Phase Therapy
|
1. counsel pt and family
2. refer them to MHAUS 3. fill out Adverse Metabolic Reaction to Anesthesia |
|
Contraindication for Halothane-Caffeine contrature test
|
1. age < 4 y.o (20 kg)
2. < 3 mos. from the event |