Malignant Hyperthermia Crisis
High-stakes metabolic emergency management. Test your rapid response, Dantrolene pharmacology, and situational leadership.
"A 12 y.o. boy is 45 minutes into a knee repair under General Anesthesia (GA) with sevoflurane and succinylcholine. You notice a sudden rise in ETCO2 from 38 to 72 mmHg, despite increasing minute ventilation. His heart rate is 155 and his temperature is 39.5C. Masseter spasm was noted on induction."
Management of the MH crisis, dantrolene dosing, and the logistics of mobilizing a team during a metabolic catastrophe.
A 'Must-Know' clinical scenario. Examiners look for immediate cessation of triggers and rapid deployment of dantrolene.
How a Board-Certified Consultant answers this scenario.
I will manage this as a suspected Malignant Hyperthermia (MH) crisis. My immediate priority is calling for help and declaring an MH emergency to mobilize the Dantrolene cart and extra staff. Simultaneously, I will stop all halogenated agents (triggering agents), change the circuit or add charcoal filters, and hyperventilate with 100% oxygen at high flows (at least 10L/min).
I will administer Dantrolene (2.5 mg/kg IV) immediately and repeat until the physiologic state stabilizes. For his hyperkalemia and acidosis, I will provide bicarbonate, glucose/insulin, and calcium. I'll initiate active cooling with ice packs and cold saline and notify the surgical team to conclude the procedure as fast as possible. I will manage his arrhythmias with standard Advanced Cardiovascular Life Support (ACLS) protocols but avoid calcium-channel blockers if Dantrolene has been given, as this combination can cause fatal hyperkalemia and cardiovascular collapse. My goal is stabilization and transfer to an ICU for 24-48 hours of monitoring.