Peds Review 2021

Question 1

S/S Malignant Hyperthermia

Answer 1

Increased EtCO2, muscle rigidity, cardiac arrest, arrhythmias, hyperthermia, acido- sis, myoglobinuria

Question 2

MH Tx

Answer 2

1. Call for help
2. Stop all triggering anesthetics, convert to TIVA, exchange anesthesia machine
3. Dantrolene 2.5 mg/kg IV (mix with sterile H2O)
4. Hyperventilate with 100% O2 to normalize EtCO2 (2-4x patient’s minute ventilation)
5. Treat hyperkalemia
6. Avoid calcium channel blockers for dysrhythmias
7. Cool patient: NG lavage with cold water, apply ice externally, infuse cold saline IV
8. . Arterial line: ABG, lytes, Ca++, CPK, AST/ALT, CK, myoglobin
9. Sodium bicarbonate 1-2 mEq/kg max 50 mEq to maintain pH > 7.2
10. Maintain 2 mL/kg/hr urine output (with diuretics if necessary)

Question 3

HYPERKALEMIA

Signs

Answer 3

Peaked T waves, Wide QRS, Cardiac Arrest

Question 4

HYPERKALEMIA

Risk factors

Answer 4

ARF/CRF, Transfusion, Burns, Trauma, GI bleeds, hemolysis

Question 5

HYPERKALEMIA TREATMENT

Answer 5

Calcium chloride 5-10 mg/kg IV until NSR
Hyperventilation
Sodium bicarb 1 mEq/kg/dose IV
D50 1 mL/kg + insulin 0.2 U/kg IV
Albuterol 5-20 mg via nebulizer
Furosemide 1 mg/kg IV PRN
Kayexalate 1-2 g/kg PO/PR