Unique Plan Description: Malignant Hyperthermia
Plan Selection Display: Malignant Hyperthermia
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2019-06-04 14:10:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-09-23 00:38:44
Available at all facilities: Yes

Malignant Hyperthermia
Diet
	NPO
		
Laboratory
	CBC with Diff
		T;N, Stat, spec type = Blood
	Comprehensive Metabolic Panel
		T;N, Stat, spec type = Blood
	Blood Gases Arterial (ABG) - MH/WH/JE
		T;N, Stat, spec type = Blood
	Blood Gases Arterial (ABG) - FH
		T;N, Stat, spec type = Blood
	Lactate
		T;N, Stat, spec type = Blood
	Magnesium Level
		T;N, Stat, spec type = Blood
	Ionized Calcium
		T;N, Stat, spec type = Blood
	Myoglobin Urine Random
		T;N, Stat, Stat, Urine Random, spec type = Urine
	CK
		T;N, Stat, spec type = Blood
	hs Troponin T - MH/WH/JE
		T;N, Stat, spec type = Blood
	hs Troponin I - FH
		T;N, Stat, spec type = Blood
	Toxicology Screen DAU - MH/WH/JE
		T;N, Stat, Urine Random, spec type = Urine
	Drug Screen Urine - FH
		T;N, Stat, Urine Random, spec type = Urine
	INR - MH/WH/JE
		T;N, Stat, spec type = Blood
	Prothrombin Time (PT) - FH
		T;N, Stat, spec type = Diagnostic Blood
		T;N, Stat, spec type = Therapeutic Blood
	PTT - MH/WH/JE
		T;N, Stat, spec type = Blood
	Partial Thromboplastin Time (PTT) - FH
		T;N, Stat, spec type = Diagnostic Blood
	D-Dimer - MH/WH/JE
		T;N, Stat, spec type = Blood
	D-Dimer Level - FH
		T;N, Stat, spec type = Blood
Diagnostic Tests
	ECG in ED
		T;N, Stat, Indication: Arrhythmia
	Chest 1 View
		T;N, Stat
IV Solutions
	Sodium Chloride 0.9%
		1,000 mL, IV, STAT, 1 Dose(s)/Time(s), 999 ml/hr
			Comment: Insert 2 large bore IVs. Use macro-tubing and add 3-way stopcock
	sodium bicarbonate 150 mEq/D5W 1000 mL
		850 mL, IV, Routine, 1 Dose(s)/Time(s), 0.5 mL/kg/hr
			Comment: Maximum dose 50 mL/hr.
		150 mEq, EVERY BAG
Medications
	dantrolene
		2.5 mg/kg, Injection, IV Push, Q5MIN, PRN see comment, STAT
			Comment: (Mix each vial with 60ml Sterile Water)Repeat as frequently as needed until the patient responds with a decrease in ETCO2, decreased muscle rigidity, and/or lowered heart rate
	dantrolene 250 mg intravenous injection
		2.5 mg/kg, Injection, IV Push, Q5MIN, PRN for see comment, STAT
			Comment: (Mix each 250 mg vial with 5 ml Sterile Water)Repeat as frequently as needed until the patient responds with a decrease in ETCO2, decreased muscle rigidity, and/or lowered heart rate
	amiodarone
		150 mg, Injection, IV Push, Once, STAT
	sodium bicarbonate 8.4%
		1 mEq/kg, Injection, IV Push, Once, STAT
Patient Care
	Notify
		Call Malignant Hyperthermia hotline 800-644-9737 STAT
	ED Cardiac Telemetry Monitoring
		T;N, Once
	Glucose POC - RN
		T;N, Once
			Comment: NOW, in ED
	Oxygen Therapy, Nurse to Administer
		Via Non-rebreathing Mask, O2 @ 15L
	Continuous Pulse Oximetry by Nurse
		T;N, Once
	Foley Catheter
		T;N, Foley, Insert, Critically ill requiring accurate output
			Comment: use temperature sensing catheter
	Cooling Blanket
		T;N, Remove if temp <38 deg C or less
	Cold Therapy
		T;N
			Comment: Apply ice to skin surface, axilla, groin and neck. Remove ice if temp <38 deg
	End Tidal CO2 (ETCO2) Monitoring
		T;N
			Comment: CONTINUOUS
	Do not give medication
		Do not use calcium channel blockers
	Enteral Tube
		Per Nasogastric Tube (NG), Insert, X Ray, lavage with 500ml cooled Normal Saline
Consults/Follow-up
	Consult Hospitalist
		Reason for Referral: malignant hyperthermia
	Consult Pulmonologist
		Reason for Referral: malignant hyperthermia
	Consult Anesthesiologist
		Reason for Referral: malignant hyperthermia

Hyperkalemia Protocol
Diagnostic Tests
	ECG
		T;N, Stat, Indication: Arrhythmia
IV Solutions
	Dextrose 10% 1000 mL w/ insulin regular 10 units
		1,000 mL, IV, Routine, T;N, 50 ml/hr
		10 units, EVERY BAG, 1 units/hr
	Dextrose 5% with 0.45% NaCl
		1,000 mL, IV, Routine, 100 ml/hr
Medications
		Discontinue any oral potassium and/or potassium IV additives already ordered(NOTE)*
	insulin regular
		10 units, Solution-Injection, IV Push, Once, STAT
			Comment: give before Dextrose
	Dextrose 50%
		50 mL, Injection, IV Push, Once, STAT
			Comment: If blood glucose < or = to 250mg/dL
	albuterol concentrate 2.5mg/0.5mL (0.5%) inh soln
		2 mL, Solution-Nebulization, NEBULIZED, Once, STAT
		4 mL, Solution-Nebulization, NEBULIZED, Once, STAT
	sodium chloride 0.9% inhalation solution
		3 mL, Solution-Nebulization, NEBULIZED, Once, STAT
		4 mL, Solution-Nebulization, NEBULIZED, Once, STAT
		Consider calcium for K+ >6.5mEq/L OR clinical signs or symptoms (cardiac conduction abnormalities, arrhythmias including bradycardia, sinus arrest, slow IVR, ventricular tachycardia, ventricular fibrillation, and asystole, muscle weakness or paralysis)(NOTE)*
	calcium gluconate
		2 gm, Solution, IV Push, Once, STAT
			Comment: Give over 3-5 minutes
		1 gm, Solution, IV Push, Once, STAT
			Comment: Give over 3-5 minutes
	calcium chloride
		1 gm, Syringe, IV Push, Once, STAT
			Comment: Give over 3-5 minutes; may cause vein irritation
	sodium bicarbonate 8.4%
		50 mEq, Injection, IV Push, Once, STAT
			Comment: Use with caution in dialysis patients
		100 mEq, Injection, IV Push, Once, STAT
			Comment: Use with caution in dialysis patients
	sodium polystyrene sulfonate
		15 gm, Suspension, By Mouth, Once, STAT
		30 gm, Suspension, By Mouth, Once, STAT
		60 gm, Suspension, By Mouth, Once, STAT
	Lokelma
		5 gm, Suspension, By Mouth, Once, STAT
		10 gm, Suspension, By Mouth, Once, STAT
Patient Care
	Cardiac Telemetry Monitoring
		T;N, Telemetry Indications: Electrolyte disorder
			Comment: Verify rhythm on initiation. Constant Indicator
	Order Lab
		T;N, K+ level 1 and 4 hrs after treatment complete
	Glucose POC - RN
		T;N
			Comment: Prior to insulin admistration and 15 min after insulin administration
		T;N+15
			Comment: 15 minutes after insulin administration
		T;N+60
			Comment: 1hr after insulin administration
	Notify MD
		Call MD if no improvement in EKG after calcium chloride administration.

ED Peripheral Lock Insert with Flush
Medications
	sodium chloride 0.9% flush injectable soln
		10 mL, Syringe, IV PUSH, Q5MIN, PRN, IV line flush, 4 hr
Patient Care
	Peripheral Lock-Insert
		T;N, Once

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase