OPEN ACCESSFebruary 1, 2012Malignant Hyperthermia and Adverse Metabolic Reactions Under Anesthesia Shawn Banks, MD, Nicholas B. Nedeff, MD Shawn Banks, MD University of Miami Leonard M. Miller School of Medicine Google Scholar More articles by this author , Nicholas B. Nedeff, MD University of Miami Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9095 SectionsAboutAbstract ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstractLife-threatening adverse metabolic reactions during anesthesia are rare events that may arise from a variety of disease states. Rare diseases are not commonly encountered during routine anesthesia training experiences, yet anesthesia providers are expected to provide expert-level diagnosis and treatment of these conditions when they do occur. Managing these conditions can also present unique challenges to effective systems-based practice as well as interpersonal and communication skills. This simulation uses a high-fidelity manikin and is intended to provide anesthesia residents and medical students with the knowledge and skills needed to accurately diagnose a malignant hyperthermic crisis and apply an effective treatment plan for the intraoperative and postoperative periods. This module has been used in the simulation curriculum of the University of Miami Leonard M. Miller School of Medicine's anesthesiology residency program. Early curriculum revisions were made in the first 2 months, based on anonymous feedback from participants. Participants were asked to evaluate the success with which each of the learning goals was met on a four-point scale with potential responses ranging from: completely, most of the time, occasionally, not at all. Data for 56 residents collected over 10 months from anonymous postsession evaluations indicated that 89.2% believed all goals were met “completely.” In the aftercare period, many of the trainees admitted that the patient counseling scenario was particularly challenging. There was a heavy reliance on the use of medical jargon and very few sought to probe the simulated patient's understanding of the preceding conversation. These failures have been identified as two significant barriers to effective physician-patient education. Anesthesiology trainees may have fewer opportunities to deliver bad news, explain medical conditions, or provide patient education when compared to their counterparts in other specialties. It also suggests an opportunity for new doctor-patient communication curriculum development for anesthesiology trainees, beyond the usual pre-anesthetic counseling. Educational Objectives By the end of this module, the learner will be able to: Apply prior medical knowledge to develop a differential diagnosis for evolving metabolic and respiratory acidosis during anesthesia.Prioritize the differential diagnosis correctly.Confirm or exclude the diagnosis of malignant hyperthermia with appropriate monitoring, lab tests, or consultations.List the minimum components of an effective initial management plan for malignant hyperthermic crisis.List the minimum components of an effective continuing management plan in the intensive care unit (verified by standardized checklist).Initiate treatment of a malignant hyperthermic crisis.Utilize existing support staff and other experts to carry out management plan as quickly as possible.Arrange for appropriate patient disposition from operating room.Compose expert-level treatment recommendations for patient care for the next 36 hours.Organize a plan to prevent repeat exposure to triggering medications.Demonstrate effective counseling of a patient that has survived a malignant hyperthermia crisis including explanation of the disorder and recommendations for genetic testing. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Appendix 1 MH Scenario 1 Case Stem for Learner.doc Appendix 2 MH Scenario 1 Anes H and P.doc Appendix 3 MH Scenario 1 ABG Results.doc Appendix 4 MH Scenario 1 Script for Operator.doc Appendix 5 MH Scenario 1 DDx Table.doc Appendix 6 MH Scenario 1 Critical Actions Checklist.doc Appendix 7 MH Scenario 2 Case Stem for Learner.doc Appendix 8 MH Scenario 2 ICU Post Acute Phase table.doc MH Curriculum Overview.doc To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2012 Banks and Nedeff. This is an open-access article distributed under the terms of the Creative Commons Attribution license.KeywordsCrisis InterventionMalignant HyperthermiaCrisis Management Disclosures None to report. Funding/Support None to report. Loading ...