Med-Surg - Musculoskeletal System, part 9: Amputations and Malignant Hyperthermia

Hi, I'm Cathy with Level Up RN. In this video, I will be talking about amputations and malignant hyperthermia. This is the last video in my med-surg musculoskeletal playlist. If you have our Level Up RN medical-surgical nursing flashcards, definitely pull those out so you can follow along. And at the end of the video, I'm going to give you guys a little quiz to test your understanding of some of the key points I'll be covering in this video. So definitely stay tuned for that.

Let's first talk about amputations which is the removal of a limb or a digit. It can happen traumatically or it could be a planned surgical amputation.

In the case of a traumatic amputation, for emergency care, you want to wrap the severed extremity in dry, sterile gauze and then you want to place it in a sealed plastic bag. That plastic bag will go into ice water. And then, of course, you're going to transport the patient to a hospital facility.

So when I was a transporter during nursing school, I once picked up a patient from the emergency room and needed to take him to the OR, and the nurse was like, "Here, take this too," and she handed me like a bucket of ice water and inside was the patient's severed finger. Again, in that bag and then wrapped in that dry, sterile gauze.

In terms of ongoing nursing care of an amputation, you definitely want to monitor the patient for bleeding and for signs and symptoms of infection. You want to treat phantom limb pain which is very common and definitely real. So sometimes traditional analgesics are effective at treating limb pain. However, sometimes some adjunct-type medications are more effective. So this would include antidepressants, beta-blockers, antiepileptic agents, as well as antispasmodic agents.

In terms of dressing the stump, we need to shrink the residual limb or the stump in preparation for fitting of the prosthetic device. So we want to wrap that stump in a figure-eight pattern. So we do not want to wrap it in a spiral fashion because that can impair blood flow to the remaining extremity. We want to use that figure-eight pattern.

In addition, in order to prevent hip flexion contractures, we want to make sure the patient is performing range of motion exercises. So we may need to help them with that.

In addition, we want to advise the patient to avoid elevating their stump. So in the immediate post-op period, it may be indicated for the patient to elevate it for like 24 or 48 hours. Beyond that, we want to avoid elevating that stump, and we want to limit the amount of chair-sitting the patient does because that can also contribute to those hip flexion contractures. And then most importantly, we want the patient to lay prone, in a prone position, so face down for 20 to 30 minutes about every three to four hours. So this will go a long way in helping to prevent those hip flexion contractures with an amputation.

Next, we're going to talk about malignant hyperthermia which is a life-threatening complication that occurs due to certain drugs used in general anesthesia.

So for example, succinylcholine is one of those drugs that can trigger malignant hyperthermia.

Signs and symptoms of this life-threatening complication include muscle rigidity, fever, tachycardia, tachypnea, dysrhythmias, as well as hypotension and cyanosis.

Altered labs that may be present with malignant hyperthermia include metabolic acidosis as well as myoglobin which is a muscle protein present in the patient's urine.

In terms of treatment, we're going to want to discontinue the surgery if possible. We're going to administer the antidote which is dantrolene, which is a muscle relaxant. We want to administer 100% oxygen and implement cooling measures such as cold IV fluids and ice packs, and then we may need to administer sodium bicarbonate for that metabolic acidosis.

All right. It's time for a quiz. I've got three questions for you. First question, why should a patient lie prone for 20 to 30 minutes several times a day following an amputation? The answer is to prevent a hip flexion contracture. Question number two, what methods should be used when wrapping the patient's stump following a below-the-knee amputation or BKA? The answer is a figure-eight pattern should be used. Question number three, what antidote should be administered to a patient undergoing surgery who is experiencing malignant hyperthermia? The answer is dantrolene.

Okay. That is it for our musculoskeletal playlist. I hope this playlist has helped you a bunch. If so, be sure to leave me a comment and like this video, and also share a link to our channel with your classmates or friends in nursing school. Take care and good luck with studying.