Malignant Hyperthermia

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Patient (ASA I, male, 30 years, 95kg, 190 cm) is on the OR under general anesthesia for planed operation of meningeoma. After preoxygenation propofol 200mg and succinylcholine 100mg was administered IV, he is successfully intubated and relaxed by rocuronium 50mg, sufentanyl 25 µg, Sevorane, O2/Air. The surgeon has finished positioning of the patient and he is ready to drape. You are coming to relieve your older colleague. What do you do after arriving at the OR first?

I´ll make some coffee, my nurse will take care of the patient.

Wrong answer

Caffeine is a stimulant, it keeps you awake, but it does not help the patient at this moment. Once more please ...


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First I check the anesthesia machine.

Wrong answer

The machine will most likely be fine, if not, the previous colleague wouldn`t start anesthesia.


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Examine carefully the documentation of the patient.

Wrong answer

If you do not know the patient's vital signs, studying the documentation is the highway to hell.


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I examine the patient ABCDE first.

Correct answer

As a diligent doctor I check vital signs, depth and quality of anesthesia and operation phase. At the same time I check the settings of the anesthesia machine, ventilator, fresh mixture of gases and depth of anesthesia.


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ABCDE: The ABCDEs approach is applicable in all clinical emergencies for immediate assessment and treatment: A (airway), B (breathing), C (circulation), D (disability), E (exposure).×
 
RR

12 bpm

HR

64 bpm

SpO2

98 %

BP

126/84 mmHg

ECG

sinus rythm

Examination:
Ventilation: VCV 400 ml, f=12/min, FiO2 40 %, PEEP 5cm H2O, EtCO2 34 mmHg = 4,5 kPa

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ABG

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CBC

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biochemistry

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