Case Study of Malignant Hyperthermia

Abstract

<h2>Poster Presentation</h2><h3>Background</h3> The purpose of this case study is to promote awareness and enhance preparedness of the rare and serious condition known as malignant hyperthermia (MH). <h3>Case</h3> A woman presented to the maternity center with ruptured membranes and contractions at 39 weeks gestation and anticipated a routine vaginal delivery. After 12 hours of labor, a cesarean was performed for suspected chorioamnionitis and fetal intolerance of labor. The epidural was utilized for surgical anesthesia. Within 30 minutes of the recovery phase, the woman's vital signs began to change. Rapid nursing assessment revealed tachycardia, tachypnea, changes in blood pressures, decreased pulse oximeter readings, and an increase in temperature to 106.7°F. Additional assistance was summoned by mobilizing the medical and obstetric rapid response teams. The anesthesiologist and obstetrician arrived at the bedside, the MH cart was immediately retrieved, and treatment was rapidly initiated. Within minutes the woman was being cooled with ice and the first dose of dantrolene sodium was being given intravenously (IV). It took a multidisciplinary team approach to provide the woman with rapid treatment and intervention. The team comprised nurses, physicians, anesthesia technicians, respiratory therapists, phlebotomists, ancillary staff, and environmental service personnel. Actions by the team included additional IV access, lab draws, arterial line placement, chest X‐ray, electrocardiogram, placement of a rectal temperature probe, additional medication preparation, and continued assessment of the woman's status. The woman began to show signs of improvement after receiving 20 vials of dantrolene sodium. She was stabilized and transferred to the intensive care unit for continued monitoring and support. <h3>Conclusion</h3> Following a visit from our accrediting body in 2012, it was identified that the obstetric unit was not adequately prepared for a MH crisis event. Recommendations were provided to implement staff education and to develop an MH cart stocked with medications and supplies needed in the event of an emergency. Staff education was initiated and drills were performed to enhance awareness and demonstrate competency. Utilizing resources from the main operating room, pharmacy, and the Malignant Hyperthermia Association of the United States (MHAUS) the MH cart was established and placed on the obstetric unit. Without the recommendations of our accrediting body, staff education, and creation of the MH cart this woman may not have survived this life‐threatening condition.