PACU FULL MOON BREAKOUT

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PACU Full Moon Breakout

Intro

On the night of a full moon, you are in PACU. A 42 year old male named Dan McCann just rolled into your bay after an emergent appendectomy. In order to escape you must recover Dann McCann.

Continue

Mission 1

Locked

Locked

Locked

Dan's PACU admission vital signs are HR 100 BP 138/84 Temp 100°F. In reviewing his medical record, you note he has no significant medical history or surgical history. He received Isoflurane for general anesthesia.

Click here to run his next set of vital signs

While assessing him you notice muscle rigidity. What do you suspect?

Local Anesthetic Systemic Toxicity

MalignantHyperthermia

STEMI

The 5 main signs of an MH Crisis are:

• Hypercarbia
• Tachycardia
• Tachypnea
• Muscle Rigidity especially in the jaw muscle
• Hyperthermia-LATE SYMPTOM

Imagine the patient is running a marathon while sleeping! Their calcium channels have decided they are not going to work anymore. So, the muscles become flooded with calcium causing a continuous state of contraction. This causes biproducts of muscle breakdown to be released: heat, CO2, mylogobin, and potassium. WOW what a mess! Then compensation occurs! Heart rate, blood pressure, and respiratory rate go up to compensate for the high CO2.

Now what!?Click to move forward!

What do you do next?

Call for help! Get the LAST Kit!

Call for help! Get the MH Cart!

Continue to monitor

OR

YOU FOUND THE MH CART! Click each drawer to view the contents!

Click here to go back to your cart!

Click here to go back to Dan McCann

Click here to go back to your cart!

Click here to go back to Dan McCann

Click here to go back to your cart!

Click here to go back to Dan McCann

Click here to go back to your cart!

Click here to go back to Dan McCann

Who else can you call for help? Hint: There is no wrong answer here! Just think about who you would call!

STAT Team

Boardrunners

OR Charge

Code Team

House Supervisors

Pre-op Charge

Unit Leadership

Mission 2

Completed

Locked

Locked

What is the medication we must give to inhibit the abnormal caclium release that is causing the muscles to spasm?

Sodium Bicarb

Ryanodex

Calcium Chloride

What is the correct dose of Ryanodex?

500mg IV Push

5mg/kg IV Push

2.5mg/kg IV Push

What do you use to reconstitue Ryanodex?Find it in the cart!

Click each drawer to view the contents!

Click here to go back to your cart!

Click here to go back to your cart!

Click here to go back to your cart!

Click here to go back to your cart!

Click here to go back to Dan McCann

Click here to go back to your cart!

Click here to go back to Dan McCann

50 mg/ml

Dan McCann weighs 80 kg. How many mg of Ryanodex does he need?

120mg

240mg

200mg

50 mg/ml

How many ml does Dan need?

5ml

4ml

3ml

Mission 3

Completed

Completed

Locked

What offsite resource provides physician to physician assistance and needs to be called during the MH crisis as quickly as possible?

AORN

Joint Commission

MH Hotline

18

180

1800

18006

180064

1800644

18006449

180064497

1800644973

18006449737

Completed

Completed

Completed

Mission 4

You have given the Ryanodex, but what a mess MH has caused! Dan is an accomplished musician with a deep love for the piano. His notes are playing in his mind as he fights for his life. Help dan find the notes for his masterpiece by looking for the supplies necessary to help him!

Get back to the MH Cart

We need the Esophageal Temperature probe for accurate temperature reading!

Click each drawer to view the contents!

Click here to go back to your cart!

Click here to go back to your cart!

Click here to go back to your cart!

Click here to go back to your cart!

We need labs and an ABG STAT!

Click each drawer to view the contents!

Click here to go back to your cart!

Click here to go back to your cart!

Click here to go back to your cart!

Click here to go back to your cart!

The ABG shows metabolic acidosis! We need Bicarb!

Click each drawer to view the contents!

Click here to go back to your cart!

Click here to go back to your cart!

Click here to go back to your cart!

Click here to go back to your cart!

I see peaked T waves! We need to get the potassium down! Do you have something in the cart that can help?

Click each drawer to view the contents!

Click here to go back to your cart!

Click here to go back to your cart!

Click here to go back to your cart!

Click here to go back to your cart!

Congratulations! You have helped Dan find his music by saving him from MH! Select the piano to play his song!

01

...Keep playing

02

...Keep playing

03

...One more

03

Try again...

Completada

Completada

Completada

Completada

Completed

Completed

Completed

Completed

Continue

Dan transferred to ICU where he will continue to recover from the MH Crisis thanks to your wonderful efforts! Congratulations! You have escaped from PACU during a full moon!

Wrong answer!

Try again

Why Bicarb?

Bicarb is given to correct metabolic acidosis as guided by blood gas analysis. In the absence of blood gas analysis, 1-2 mEq/kg should be administered. CLICK HERE to continue to the next task!

Institute Cooling Measures

• Infuse cold NS IV solutions (Iced saline available in the following areas: OR, ICU, CICU, CVICU, ED, Cath Lab, GI Lab) • Ice major arteries (groin, axilla, neck) • Insert OG or NG tube – ice lavage with NS • Insert foley – ice lavage with NS • Insert rectal tube – ice lavage with NS CLICK HERE to continue to the next task!!

Treat hyperkalemia (K > 5.9 with EKG changes):

• Calcium Chloride 1-2 gms IVP x1
• Calcium Gluconate 2-3 gms IVP x1

Dextrose + Insulin for Hyperkalemia:

• Blood glucose < 150: D10W 250 ml over 10 minutes followed by regular insulin 10 units IVP x1
• Blood glucose 151-250: D10W 125 ml over 5 minutes followed by regular insulin 10 units IVP x1
• Blood glucose >251: No D10W, give regular insulin 10units IVP x 1

CLICK HERE to continue to the next task

We will need to send STAT ABGs, CBC with diff, PT, PTT, INR, BMP, Lactate, CPK, liver panel, and a glucose CLICK HERE to continue to the next task!