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985: MULTIDISCIPLINARY RESPONSE TO MALIGNANT HYPOTHERMIA CASES WITH A CART AND PROTOCOLIZED RESPONSE TEAM

Learning Objectives: A 22 YO male was admitted for an open distal humerus fracture sustained after getting his arm caught in a steel press. While in the operating room (OR) undergoing fixation he began developing signs and symptoms of malignant hyperthermia (MH). The initial symptom were sustained tachycardia, hypercapnia, hypertension, and increasing body temperature. The patient’s extremities were assessed and found to be rigid. A protocoled and well-rehearsed response allowed for the successful, multidisciplinary response to a patient with suspected MH. Methods:When a case is suspected, a page for “anesthesia STATMH crisis” is called, which triggers a multidisciplinary response. An MH cart is bought to the OR room and the OR pharmacist and clinical pharmacists are paged to the room. Color-coordinated cards are assigned to determine roles and responsibilities for the primary nurse, cooling nurse, medication nurse, dantrolene nurse, and two recorders. The presence of clinical pharmacists allows for correct dantrolene product selection, and swift preparation of the drug, especially given the 2 brands of dantrolene: Ryanodex and Revonto. The cart contains 1 vial of Ryanodex for the first dose, and 9 vials of Revonto for any subsequent dosing. Having a minimum of 2 pharmacists respond to an MH crisis allowed the correct form of dantrolene to be prepared in the most time-effective manner. The presence of an OR based pharmacist allows for a rapid response time to this crisis. Additional roles pharmacists may play include dantrolene redosing, treatment of hyperkalemia, as well as determining the scheduled doses that will be provided over the following 24 hours. Results: This case highlights the importance of multi-disciplinary involvement in these rare, but potentially fatal cases. The MH cart allows all the providers to quickly understand their role within the stabilization and recovery of the patient and to centralize all of the supplies needed.