Aside from immediate pharmacological intervention, the acquisition of arterial access becomes imperative for the repeated blood gas and laboratory analysis. Hyperkalemia, a common feature in a MH crisis, requires urgent attention and is managed with treatments such as calcium gluconate, insulin/dextrose, sodium bicarbonate, and albuterol. Metabolic acidosis, another frequent accompaniment, might benefit from sodium bicarbonate administration.
MH patients are often vulnerable to cardiac arrhythmias. While these generally respond to standard interventions, it's critical to note that the concurrent administration of calcium channel blockers with dantrolene is contraindicated due to the potential escalation of hyperkalemia and myocardial depression.
For patients presenting with severe hyperthermia, rapid cooling becomes imperative. Employing cold blankets, chilled IV fluids, ice packs, and even dropping the room's ambient temperature can be beneficial. Severe cases might even necessitate peritoneal lavage with cold saline.
Additionally, the placement of a urinary catheter aids in monitoring urine output and mitigating the risk associated with myoglobinuria.
| Problem | Management |
|---|---|
| Need for repeated blood gas and laboratory sampling | Obtain arterial access |
| Hyperkalemia | Calcium gluconate, insulin/dextrose, sodium bicarbonate, and albuterol |
| Metabolic acidosis | May benefit from sodium bicarbonate |
| Cardiac arrhythmias | Generally respond to standard interventions; calcium channel blockers with dantrolene are contraindicated because of worsening hyperkalemia and myocardial depression |
| Severe hyperthermia | Cold blankets, chilled IV fluids, ice packs, and lowering ambient room temperature; peritoneal lavage with cold saline in severe cases |
| Myoglobinuria | Place a urinary catheter to monitor urine output and mitigate the associated risk |
| Oxygenation and ventilation | Optimize, targeting a fall in ETCO2 and inspired oxygen raised to 100% |
