Outpatient Surgery Magazine

Bring It On- December 2020 - S...

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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6 8 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • D E C E M B E R 2 0 2 0 needs to do without confusing them in the process (see the sidebar below). For instance: Stop: Immediately discontinue the volatile anes- thetic and succinylcholine. Help: Call for help and alert the surgeon to conclude the procedure promptly. Treatment Action Step Stop Immediately discontinue the volatile anesthetic and succinylcholine. Help Call for help and alert the surgeon to conclude the procedure promptly. Administer Dantrolene Prepare and administer 2.5 mg/kg dantrolene IV bolus and repeat as necessary every five to 10 minutes until symptoms abate. Hyperventilate Administer 100% oxygen at high flows (at least 10 L/min) through new circuit tubing. Cool If fever is present, initiate cooling by lavage administration of chilled IV normal saline and surface cooling. Stop cooling measures at core body temperature of 38.5°C. Treat Dysrhythmias Dysrhythmias will usually respond to treatment of acidosis or hyper- kalemia. Treat persistent or life-threatening arrhythmias with standard antiarrhythmic agents. Important: Do not administer calcium channel blockers with dantrolene. Check Labs Check arterial blood gases, serum electrolytes and blood glucose until syndrome stabilizes. Also check coagulation profile, CK, blood and urine myoglobin, and liver enzyme levels. Treat Hyperkalemia Treat hyperkalemia with hyperventilation, bicarbonate, and IV insulin and glucose. For refractory hyperkalemia, consider albuterol, Kayexalate, dialysis or extracorporeal membrane oxygenation if patient is in cardiac arrest. Correct severe metabolic acidosis with sodium bicarbonate, 1 mEq/kg to 2 mEq/kg, guided by pH and base deficit. Maintain Urine Output Maintain urine output greater than 1 ml/kg per hour with hydration, furosemide (0.5 to 1.0 mg/kg) and mannitol as needed. CLEAR & CONCISE 9 Straightforward Steps in Treating MH We created a quick-reference guide to direct our staff's MH response by breaking down each treatment step, starting with stopping the use of the triggering agent and ending with ensuring the patient maintains urine output, into broad actions. Download a copy of the form at outpatientsurgery.net/forms. — Jasmine Hampton, BSN, RN, CNOR CALL TO ACTION Surgical teams must respond without hesitation to save a patient's life. VA Southern Nevada Healthcare System

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