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Using a Vulnerability Theoretical Model to Assess the Malignant Hyperthermia Susceptible Population: Implications for Advanced Practice Emergency Nurses

Denholm, Bonnie G. DNP, RN, CNOR

doi: 10.1097/TME.0000000000000073

Malignant hyperthermia (MH) is a high-risk, low-occurrence medical emergency with symptoms that include a severe increased rate of metabolic activity and rigid skeletal muscles. Clinicians should be knowledgeable and prepared for an MH event because it can occur in areas outside the operating room and without anesthetic triggers. Patients who have this rare genetic condition may come to the emergency department (ED) presenting with symptoms of heat stroke. However, the incidence of suspected MH in the ED or other critical care areas is not easily quantifiable because clinicians may not report cases to a centralized registry. The purpose of this article is to describe the MH-susceptible vulnerable population, to apply a vulnerability theoretical model to assess patients and families, to identify strategies for health promotion to reduce vulnerability, and to discuss how advanced practice nurses who specialize in emergency care can help decrease the vulnerability of MH-susceptible patients and families. By using a vulnerability model to assess the MH-susceptible population, nurses can effectively sort out strategies to prevent poor patient outcomes related to MH and promote health for this high-risk population. Measuring accurate core temperatures, applying effective cooling methods, and administering dantrolene are key concepts in caring for a patient who is experiencing an MH event. Advanced practice emergency nurses can participate in reducing vulnerability for this population by applying the Emergency Nurses Association Clinical Nurse Specialist competencies to MH-related vulnerabilities. Enhancing preparedness, evaluating and coordinating education programs, advocating for report submissions to the North American Malignant Hyperthermia Registry, and assessing opportunities for community collaboration are among the strategies discussed for reducing vulnerability for the MH-susceptible population.

Western University of Health Sciences, Pomona, California.

Corresponding Author: Bonnie G. Denholm, DNP, RN, CNOR, Western University of Health Sciences, 309 E 2nd St, Pomona, CA 91766 (

The author thanks Barbara W. Brandom, MD, Rodney Hicks, PhD, APRN, FAANP, FAAN, and Lisa Spruce, RN, DNP, CNS-CP, ACNS, ACNP, CNOR, for their support.

Disclosure: The author is currently serving on the MHAUS Board of Directors. No funding was received from the association or any affiliates for the preparation of the manuscript.

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