Nevada Team Improves Local Training for Rare Emergency - VHA SimLEARN
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Nevada Team Improves Local Training for Rare Emergency

By Lichelle Bevett, MSN Ed, CPAN, RN
Post Anesthesia Care Unit RN
VA Southern Nevada Healthcare System

LAS VEGAS – Lichelle Bevett, the VA of Southern Nevada Healthcare System (VASNHS) post anesthesia care unit’s (PACU) simulation instructor, and Quentin Hart, VASNHS simulation coordinator, recently teamed up to create a realistic simulation designed for the PACU environment focusing on recognizing malignant hyperthermia (MH) signs and symptoms in a standardized patient. This approach also alerts the team to determine, mix and administer the required medication and monitor the patient after treatment.

For many years, training on MH for the PACU and operating room (OR) staff at the VASNHS consisted of watching a video from the Malignant Hyperthermia Association of the United States (MAUS) and reviewing the contents of the MH cart. There was no opportunity for the participants to simulate the actual response to an MH event.

According to Mullins (2017), MH is a very rare genetic disease caused by general anesthetic gases and the skeletal muscle relaxant, succinylcholine which causes symptoms of muscle rigidity, high fever and an increased heart rate. Although malignant hyperthermia is very rare, occurring in 1 out of 100,000 surgeries, if not quickly treated, it can lead to death (MAUS, 2019). Since MH is very rare and requires prompt recognition and immediate action, the VASNHS OR and PACU found it more suitable to take a more innovative approach to its annual OR/PACU MH training with virtual simulation.

A standardized patient was briefed on the symptoms to exhibit during the simulation and an instructor computer and monitor were used to display vital signs consistent with MH. Mock vials of Ryanodex, the medication used for MH, were constructed using empty medication vials and an orange-colored drink mix to give participants the experience of mixing the medication based on the patient’s weight. The participants were prepared for the simulation by reviewing a didactic slide presentation lecture entitled, “Managing Malignant Hyperthermia in the PACU.” The lecture provided guidance on the key objectives and roles for the PACU nurses during an MH situation.

On May 16, the newly-created malignant hyperthermia simulation was conducted in the PACU. Nurses and anesthesia providers were chosen to play roles during the mock MH crisis. Due to the extensive training on MH, the nurses remembered their roles and promptly knew the signs and symptoms of MH, quickly retrieved the MH cart, and mixed and administered the mock Ryanodex.

During their debriefing, lead simulation nurse Jim Carr said, “I thought we did well as a team, and we communicated very well.” Other nurses shared how beneficial and realistic it was to mix and administer the mock Ryanodex medication. The participants commented the MH simulation was beneficial for the unit.

Although malignant hyperthermia is very rare, PACU nurses using hands on practice along with video instruction provides an opportunity to deliver safe and confident training for more vigilant nursing practice during these rare occurrences.


Malignant Hyperthermia Association of the United States [MAUS]. (2019) Frequently asked questions. Retrieved from:

Mullins, M.F. (2017). Malignant hyperthermia: A review. Journal of PeriAnestheisa Nursing, 33(4), 582-589.