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Post-traumatic stress disorder — MCCQE Part 1 MCQ

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HardSubstance UsePost-traumatic stress disorderMCCQE Part 1

During surgery with sevoflurane and succinylcholine, a patient develops rapidly rising end-tidal CO₂, generalized rigidity, tachycardia, hyperkalemia and a temperature of 39.8°C. What is the best immediate treatment?

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Correct answer: A — Stop triggers and give intravenous dantrolene

The rapid rise in carbon dioxide, rigidity, tachycardia, hyperkalemia and hyperthermia after volatile anesthetic and succinylcholine exposure is malignant hyperthermia. Stop all triggering agents, call for the malignant-hyperthermia cart and assistance, hyperventilate with 100% oxygen, and administer intravenous dantrolene promptly. Active cooling, treatment of hyperkalemia and acidosis, urine-output support and serial monitoring for rhabdomyolysis and recurrence follow in parallel. Laboratory confirmation must not delay treatment. Acetaminophen is ineffective because this is uncontrolled skeletal-muscle metabolism rather than a hypothalamic fever.

Reference: NIH—Malignant Hyperthermia: https://www.ncbi.nlm.nih.gov/books/NBK430828/