Malignant Hyperthermia (MH) Update/Reminders

Do pharmacists respond to a CODE MH?
No. If more dantrolene is needed, someone will call ext. 58282 for Huntsville Hospital, or ext. 75037 for Madison Hospital, and say "I need to speak to a pharmacist. I am in a code/emergency". The pharmacist in central pharmacy can tube the dantrolene, or it may be picked up or requested to be delivered to them.

Who responds to a CODE MH?
Anesthesiologist and/or additional physicians, CRNA, Anesthesia Technician, Respiratory Therapist, and Code 0 ICU RN

Where are the MH carts and MH kits located and who takes them to a CODE MH?

Location of HHM, W&C, and GMT MH Carts:

• MH carts: HHM OR (1), W&C OR (1), and GMT OR (1)

Location of MH Kits at HHM, W&C, and GMT:

• MH kits are loaded in the following Pyxis devices: ANESTHESIA, WC_OR-1, and GMT-OR
• If a CODE MH is called, the anesthesia technician retrieves the MH cart and MH kit from the nearest location.

Location of Madison Hospital MH Carts:

• Madison Hospital Anesthesia workroom (just inside the OR double doors to the left) - contains Ryanodex #6 x 250 mg vials
• MH ENDO area, 2nd floor Madison Medical I Bldg - contains Ryanodex #3 x 250 mg vials

Location of MH Kits at Madison Hospital:

• MH_SURGERY Pyxis
• MH_ENDMAIN Pyxis (ENDO PreOp/PACU)

What is included in the MH kit retrieved from the Pyxis?
The "MH *REF* KIT" contains 3 liters of cooled saline and 1 vial of regular insulin. These kits are prepared by the surgery pharmacy technicians in RxVerify. Should you need to refill a Pyxis device, there is always one kit made and available on the carousel in Central Pharmacy (refrigerator 18).

What is the dosing for dantrolene (RYANODEX) and where is it located?
The dantrolene dose is 2.5 mg/kg IV (3 X dantrolene (RYANODEX) 250 mg vials in each MH cart, reconstitute with sterile water); maintenance dose is 1 mg/kg IV q 4-6 hrs x 24-48 hours or 0.25 mg/kg/hr.