17 y/o male presents in severe respiratory distress secondary to asthma exacerbation. Patient is intubated using combination of etomidate and succinycholine. 10 minutes later he begins to take a turn for the worse becoming rigid, febrile (108 F), tachycardic and acidodic (both metabolic and respiratory). What is the diagnosis? Treatment?

Malignant hyperthermia, is an entity often written about (as in this vignette) but rarely - if ever - seen in the emergency medicine community.  In a brief review of the literature, I found no case reports of malignant hyperthermia presenting in the ED.  While malignant hyperthermia can occur after administration of succinycholine alone, it is a more common complication in the OR where succinycholine is combined with inhaled anesthetic gases .  Treatment is dantrolene, a drug with minimal side effects, which will decrease mortality from as high as 70 percent to between 1 and 17 percent. 


Source

Litman, R.  "Malignant hyperthermia: Clinical diagnosis and management of acute crisis"  Up to Date.  May 2011.

Rosero, E.  et al.  "Trends and Outcomes of Malignant Hyperthermia in the United States, 2000 to 2005.  Anesthesiology.  2009.