CATACHOLAMINE SECRETING TUMOR EXTRACTION-

CHECK PRE-OP FOR BREAK DOWN PRODUCTS VMA–

END ORGAN BLOCKADE REGITINE/PHENOXYBENZAMINE (ALPHA-ADRENERGIC BLOCKADE)–10 MG PO Q 12 HOURS — TOO MUCH –POSTURAL HYPOTN

+ BETA BLOCKADE

POST OP SODIUM NITROPRUSSIDE

NO HYPERPYREXIA

THYROTOXIC CRISIS

+ FEVER/HYPERPYREXIA (DIFFERING FROM THYROTOXICOSIS)

USUALLY HAPPENS IN PTS WITH DIFFUSE TOXIC GOITER (GRAVE’S Dz) WITH UNDERLYING STRESS–SUCH AS SURGERY OR INFXN

TEMP > 101

PROFUSE SWEATING

TACHY

ANGINA

DYSRYTHMIAS-CHF

N/V

DELERIUM,APATHY,STUPOR

Rx: INHIBITION OF HORMONE SYNTHESIS (PTU 200 MG PO Q 4 HOURS)

INHIBITION OF THYROXINE RELEASE (SSKI 5 DROPS Q 6 HOURS)

B- BLOCKADE (INDERAL)

COOLING BLANKET

IVF

O2

STEROIDS

MALIGNANT HYPERTHERMIA

DESCRIBED IN 1960

SUSPECT EVERYONE-HIGH IN PEDS PTS

ABNL IN THE SARCOPLASMIC RETICULUM

HYPERMETABOLIC (HYPERPYREXIC) STATE CAUSED BY TRIGGERING SUBSTANCES–SUCCINYL CHOLINE AND VOLATILE GASES

Dx: VASTAS LATERALIS Bx

CAFFEINE-HALOTHANE CONTRACTURE TEST

EARLY SIGNS OF HYPERMETABOLIC STATE

TACHY, MET ACIDOSIS, HYPOXEMIA, HIGH END TIDAL CO2, SKIN MOTTLING, UNSTABLE BP, MASSETER STIFFNESS(RIDGIDITY),WHOLE BODY RIDGIDITY, HTN—–HYPERPYREXIA (BY THE TIME TEMP RISES IT IS TOO LATE!)—-PYREXIA > 43 DEGREES—DIC—MSOF—-DEATH

MORTALITY > 10 % EVEN WHEN TREATED

STOP ALL TRIGGERING AGENTS

100% O2

HYPERVENTILATE

DANTROLENE 2.5 MG/KG IMMEDIATELY

SODIUM BICARB 1MEQ/KG

GLUCOSE 0.5GM/KG; INSULIN 0.15 U/KG

IVF

COOLING BLANKET

LASIX—-PREVENT ATN FROM MYOGLOBINURIA

TREAT TACHY–DYSRYTHMIAS (PROCAINAMIDE/PROCARDIA)