How should I manage a patient suspected of having malignant hyperthermia in a primary care setting before they are referred to a specialist?

Management of a patient suspected of malignant hyperthermia in primary care before specialist referral:

• Malignant hyperthermia is a rare, life-threatening reaction usually triggered by certain anaesthetic agents; it requires urgent recognition and emergency management.

• In a primary care setting, if malignant hyperthermia is suspected (for example, following exposure to triggering agents during a procedure), immediate emergency treatment should be initiated, including calling emergency services for urgent hospital transfer.

• Supportive measures include stopping triggering agents, providing 100% oxygen, and cooling the patient if hyperthermia is present.

• Dantrolene sodium is the specific antidote but is not typically available in primary care; therefore, rapid transfer to a specialist centre or hospital with intensive care facilities is essential.

• While awaiting transfer, monitor vital signs closely and provide supportive care as needed.

• After emergency treatment and stabilization, refer the patient to a specialist centre with expertise in malignant hyperthermia for further assessment, genetic testing, and long-term management advice.

Note: The provided UK guidelines do not specifically detail malignant hyperthermia management in primary care; however, principles of emergency recognition, supportive care, and urgent referral to specialist services apply, consistent with management of other acute life-threatening reactions such as anaphylaxis ².