Dr. Gavin Parker PINCHER CREEK AB MALIGNANT
Society of Rural Physicians of Canada26TH ANNUAL RURAL AND REMOTE MEDICINE COURSEST. JOHN'S NEWFOUNDLAND AND LABRADORAPRIL 12 - 14, 2018Dr. Gavin Parker PINCHER CREEK AB 140MALIGNANT HYPERTHERMIAMalignant hyperthermia is a rare and serious complication of providing a general anestheticor a potential reaction to medicines given in the rural ED. Using a case from a rural OR wewill discuss management of this case and how to avoid a similar outcome in your facility.1. Compare MH Physiology and epidemiology 2.Discuss Clinical manifestations 4.Differentialdiagnosis and treatment 5.Case review 6.MH resources
4/26/2018Gavin G. Parker, B.Sc., M.Sc. (Med. Ed.), M.D., C.C.F.P.(FPA)Rural Medicine and GP-AnesthesiaCommunity Medical Director - Pincher Creek Health CentreClinical Assistant Professor, University of Calgary11
4/26/2018 Physiology and epidemiology Clinical manifestations Differential diagnosis and treatment Case review MH resources3 Inherited disorder of skeletal muscle Problem w/ reuptake of intracellular Ca2 Exact cause uncertain Ryanodine receptor Disease inheritance is autosomal dominant42
4/26/2018 Definite association: central core disease Possible association: Duchenne, Becker,King-Denborough, other myopathies Coincidental association: neurolepticmalignant syndrome, SIDS, Lymphomas, andHeat Stroke5 Frequency 1:3,000 - 1:60,000 anestheticcases Approximately 600 cases per year in U.S1 Increased incidence in young adult males 1:100,000 hospital discharges complicatedby MH63
4/26/2018Muscle ContractureTest Caffeine HalothaneContractureTest(CHCT) Gold StandardGenetic Testing Ryanodine receptor(RYR1 Gene) Primary genetic focus DNA blood test orbiopsy MH Muscle BiopsyCenter7MH Triggers Potent volatileanesthetics SevofluraneDesfluraneIsoflurane Depolarizing musclerelaxants NOT MH Triggers Nitrous oxide IV induction agents Non-depolarizingmuscle relaxants OpioidsSuccinylcholine84
4/26/2018Specific Muscle rigidity* Increased CO2production Marked temperatureelevation RhabdomyolysisNon-Specific Tachycardia Tachypnea Acidosis (respiratory;metabolic) Hyperkalemia9 Insufficient anesthesiaor analgesia Insufficient ventilationor FGF Anaphylactic reaction Pheochromocytoma Cerebral ischemia Neuromusculardisorders Procedural causes Malignant neurolepticsyndrome Thyroid crisis105
4/26/2018 Stop triggering inhalationagents/succinylcholine Hyperventilate high flow 100% O2 Dantrolene 2.5mg/kg push, repeat prn Continue monitoring & interventions Treat hyperthermia, acidosis, andarrhythmias11 Muscle relaxant Indications The only specific and effective treatment for MH Neuroleptic malignant syndrome, muscle spasticity,serotonin syndrome, and 2,4-dinitrophenol poisoning Drug Interactions CCBs, NDNMB, CNS depressants & benzodiazepines126
4/26/2018 Shut down/disable vaporizers Flow O2 10L/min for 20 minutes throughmachine and ventilator Change CO2 absorbent Use non-trigger agents and methods Monitor for early signs of MH13 6 year old for dental surgery, no family history ofanesthetic issues Gas induction with sevoflurane, tube changedhalfway through case with succinylcholineassistance EtCO2 increased, never did get hyperthemic Eventually had muscle bx, confirmed spont. mut.147
4/26/2018 Site specific policy Malignant Hyperthermia Cart MHAUS Malignant Hyperthermia Association of theUnited States @ 1-800-MH-HYPER www.mhaus.org15 Disorder with intracellular Ca2 effectingskeletal muscle Triggered by inhaled anesthetics &succinylcholine Specific and non-specific clinical signs Definitive treatment with Dantrolene168
4/26/2018 Call for help (let surgeon know) Turn off potential triggering agents Administer dantrolene 2.5 mg/kg every fiveminutes Cool patient to 38C Monitor and correct blood gases, electrolytesand glucose17 Brady, J.E., Lena, S.S., Rosenberg, H., Li, G. (2009). Prevalance of malignanthyperthermia du to anesthesia in new york state, 2001-2005. Aneshtesia &Analgesia. 109:1162-1166. Glahn, K.P.E, Ellis, F.R., Halsall, P.J., Muller, C.R., Snoeck, M.M.J., Urwyler, A., &Wappler, F. (2010) Recognizing and managing a malignant hypthermia crisis:guidelines from the European Malignant Hyperthermia Group. British Journalof Anaesthesia. 105 (4):417-420. Rosenburg, H., Brandom, B.W., & Sambuughin, N. (2009). Malignant Hyperthermiaand Other Inherited Disorders. In P.G. Barash, B.F. Cullen, & R.K. Stoelting.(Eds.) Clinical Anesthesia (6th ed., pp. 598-619). Philadelphia: LippincottWilliams & Wilkins Stoelting, R., & Hiller, S. (2006). Handbook of Pharmacology & Physiology inAnesthetic Practice (2nd Ed). Philadelphia: Lippincott Williams & Wilkins Torpy, J., Lynm, C., Glass, R.M. (2005). Malignant Hyperthermia. JAMA; 293 (23):2958189
MALIGNANT HYPERTHERMIA Malignant hyperthermia is a rare and serious complication of providing a general anesthetic or a potential reaction to medicines given in the rural ED. Using a case from a rural OR we will discuss management of this case and how to avoid a similar outcome in your facility. 1.
Martin Creek 21, 22 Mud Creek 14, 15, 38 North Oconee River 30 Orr Creek 08, 09 Pitts Creek 38 Sardis Creek 22, 27 Sawnee Creek 05, 10 Shoal Creek 01, 02, 03 Short Creek 16, 17 Six Mile Creek 07, 11, 12 Split Oak Creek 32 Squirrel Creek 27, 33 Taylor Creek 20, 21, 24 T
Silver Creek Tributary #1 Bear Creek Alderwood Creek Lower Spring Creek Baker Creek Tributary Lower Baker Creek Lower . Project Area Legend XX-RR1 XX-RP1 FR 150 XX-WP1 150. Figure 11. Chuckanut Creek Sub-watershed: HRTA Tier 1 Summary . Bug Lake Sunset Pond Squalicum Creek Spring Creek Baker Creek South Fork Baker Creek Hannegan Rd d
Langhorne Creek) LC10 (AS805397, Langhorne Creek) Selected from a SARDI trial in Langhorne Creek 1977-19804. Introduced into WA in 20023. LC14 (IW056133, Langhorne Creek) LC14 (AS805398, Langhorne Creek) Selected from a SARDI trial in Langhorne Creek 1977-19884. Introduced into WA in 20053. LC84 (IW056132, Langhorne Creek) LC84 (Langhorne Creek)
Battle Creek, MI 49017 BattleCreek.org 269.962.4076 P. 3 President's Welcome Letter P. 6 Parks of Battle Creek P. 8 Living in Battle Creek P. 10 Demographics of Battle Creek P. 12 Schools of Battle Creek P. 14 Calhoun County P. 16 Employment around Battle Creek P. 18 Top Attractions P. 24 Transportation in Battle Creek
Jul 14, 1989 · The Gavin family joins the in- dustry in mourning one of our most brilliant contemporaries. Rick was very close to our founder, Bill Gavin, who helped him with direction and advice. On the occasion of our 25th Anniversary, Rick was given a Gavin award as a leader in our industry. Top 40 Editor sDáve Sholin remembers, "No one
Lower Russian River Guerneville East Austin Creek Ward Creek-Austin Creek Green Valley Creek Porter Creek-Russian River Dutch Bill Creek-Russian River Willow Creek-Russian River . REC-1 is a year-round beneficial use of the Russian River Watershed. Statewide bacteria objectives for the protection of REC-1 are established using . E. coli
Beaver Creek 01-05 P Des Moines River 06-09 P Dovetail 10 P Fourmile Creek 11-24 P Frink Creek 25 P Jordan Creek 26-32 P Little Beaver Creek 33-39 P Little Beaver Creek Tributary A 40-41 P Little Beaver Creek Tributary North 42 P Little Beaver Cree
Safety-sensitive employees of city, county or other public transit services are subject to alcohol and drug testing requirements under rules issued by the Federal Transit Administration (FTA), a DOT agency. Additionally, employees who operate a vehicle requiring a commercial driver's license (CDL) are subject to substance abuse testing. This expansion of the scope of the Federal Motor Carrier .
