MH treatment — call, cool, dantrolene
Malignant hyperthermia management
Mnemonic device
Stop · Call · Cool · Dantrolene
Mapping
Stop
Stop volatile + succinylcholine. Switch to TIVA. Hyperventilate 100% O2 at 10 L/min.
Call
Call MH hotline 1-800-MH-HYPER (1-800-644-9737). Get extra hands. Have someone bring the MH cart.
Cool
Cold IV NS, ice packs to groin/axilla, cold gastric/bladder lavage. Stop cooling at 38°C — avoid overshoot.
Dantrolene
Dantrolene 2.5 mg/kg IV bolus, repeat q5 min until symptoms resolve. Max ~10 mg/kg. Reconstitute Ryanodex (250 mg/vial) faster than original (200 mL → 5 mL).
Clinical note: Treat hyperK with calcium + insulin/glucose + bicarb. Treat arrhythmia (avoid CCBs — interact with dantrolene). Continue dantrolene 1 mg/kg q6h × 24 h post-event. ICU monitoring 24-48 h.