Anonymous Submission Form for MH Events

General information

This form allows you to anonymously submit an occurence of a Malignant Hyperthermia event. After submisson, a unique event identification key (UEIK) will be created and displayed. Please indicate this UEIK in the patient registration at the MH diagnostic laboratory of your choice.

Thank you for your participation!

Patient sex male
female
no information

Family history of MH yes
no
no information

Type of surgery Please give a short description of the type of surgery...

no information

Ventilation spontaneous
mechanical
assisted
no information

Maximum minute ventilation Please indicate the maximum [l/min].
Valid range: 0 — 30 l/min

max. l/min
no information

Breathing system rebreathing
circle
no information

Tachycardia Please indicate the maximum [beats/min].
Valid range: 30 — 250 beats/min

max. beats/min
no information

Arrhythmia yes
no
no information

Increased CO₂ Please indicate the maximum CO₂ [kPa].
Valid range: 4 — 25 kPa

kPa
no information

Timing: CO₂ Time [minutes] from induction of anaesthesia to 1^st evidence of increase in CO₂ production.

minutes
no information

Timing: temperature Time [minutes] from induction of anaesthesia until temperature increase of 1°C.

minutes
no information

Metabolic acidosis Please indicate the minimum BE.
Valid range: -20 — +5 BE

BE
no information

Masseterspasm yes
no
no information

General muscle rigidity yes
no
no information

Hyperthermia Please indicate the maximum temperature [°C].
Valid range: 35 — 45 °C

°C
no information

Succinylcholine yes
no
no information

Dantrolene treatment yes
no
no information

Dantrolene dose [mg]:
Treatment during first 2 hours after diagnosis.
Valid range: 0 — 2'000 mg

mg
no information

Suspected MH survived yes
no
no information

Recrudescence of MH yes
no
no information

Patient referred to Please indicate the name of the MH diagnostic laboratory...

no information

Your UEIK:
After successful submission, your UEIK will be displayed here.