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EMHG - Anonymous Submission Form for MH Events

General information

This formular 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 participation!

Patient sex


Patient age




Patient body weight






Family history of MH


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


Ventilation



Maximum minute ventilation Please indicate the maximum [l/min].

max. l/min

Breathing system


Tachycardia Please indicate the maximum [beats/min].

max. beats/min

Arrhythmia


Increased CO2 Please indicate the maximum CO2 [kPa].

kPa

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

minutes

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

minutes

Metabolic acidosis Please indicate the minimum BE.

BE

Masseter spasm


General muscle rigidity


Hyperthermia Please indicate the maximum temperature [°C].

°C

Succinylcholine


Volatile anaesthetics




Stimulating drugs




Dantrolene treatment



Dantrolene dose [mg]:
Treatment during first 2 hours after diagnosis.
mg

Suspected MH survived


Recrudescence of MH


Complications





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



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