Malignant Hyperthermia for the New Hampshire RSI Paramedic

1
Malignant Hyperthermia for the New Hampshire RSI
Paramedic

• Christopher A. Fore MD, FACEP
• EMS Medical Director
• Concord Hospital

2
What is Malignant Hyperthermia

• An extremely rare autosomal dominant genetic
  disorder (approx 150,000)
• Hypermetabolism and extreme muscular rigidity are
  the hallmark findings
• A rare complication of depolarizing paralytic
  agents, especially when combined with inhaled
  anesthetic gases

3
What Actually Happens?

• Excessive calcium release inside muscle cells
• Dramatic increased muscle tone ensues
• Heat is released during this process
• Increased oxygen consumption and carbon dioxide
  production
• Uncontrolled hyperthermia and cell death

4
How Severe is the Reaction?

• Untreated, mortality is 70
• Treated aggressively, the mortality can be
  reduced to 5
• Malignant hyperthemia IS NOT an allergic
  reaction, and is therefore NOT treated as an
  allergic or anaphylaxic reaction

5
Will I Recognize This?

• Malignant hyperthermia is characterized by
• Very notable sustained muscular contractions
• Hyperventilation
• Hyperthermia
• Flushing of the skin may occur, although cyanosis
  can also ensue if the condition is worsening

6
What Can I Do?

• Manage the airway
• Malignant hyperthermia can cause masseter spasm
  (clenched jaw) and can therefore make managing
  the airway difficult.

7
What Can I Do?

• Cool the patient
• Cold packs
• Lower the temperature of the ambulance
• IV fluid boluses

8
What Can I Do?

• Identify malignant hyperthermia
• Alert receiving facility of potential malignant
  hyperthermia
• They will need to quickly obtain dantrolene
  sodium to treat the patient

9
What Can I Do?

• Continue to care for the patient
• Dont forget to treat the underlying
  medical/surgical process that required the use of
  succinyl choline administration

10
What Will Happen at the Hospital?

• Dantrolene sodium infusion will be given
• Aggressive cooling
• Support of electrolyte abnormalities and renal
  function
• ICU stabilization

11
Summary Malignant Hyperthemia

• What Happens
• Profound muscular rigidity
• Hyperthermia
• Tachycardia
• Flushing of skin

• What to Do
• Manage the airway
• Cool the patient
• Give IV fluids unless contraindicated
• NOTIFY RECEIVING HOSPITAL OF CHANGE IN CONDITION