What is the specific treatment for malignant hyperthermia?

Dantrolene sodium. Dantrolene sodium is the ONLY specific treatment for malignant hyperthermia. It works by blocking calcium release from the sarcoplasmic reticulum in skeletal muscle, stopping the hypermetabolic cascade. The initial dose is 2.5 mg/kg IV, repeated as needed. Every surgical suite must have an MH cart with dantrolene readily available.

Which of the following is the first sign that may indicate malignant hyperthermia during general anesthesia?

Unexplained rise in end-tidal CO₂ and tachycardia. An unexplained rise in end-tidal CO₂ (ETCO₂) is often the EARLIEST sign of malignant hyperthermia, reflecting the hypermetabolic state producing excess carbon dioxide. Tachycardia and muscle rigidity (especially masseter/jaw rigidity) are other early signs. Temperature elevation may occur later.

What is the recommended method for transferring sharps (scalpels, needles) between the surgeon and surgical technologist?

Using a neutral zone (hands-free technique). The neutral zone (hands-free passing technique) is the recommended method for transferring sharps. A designated zone on the Mayo stand or a passing basin is used — one person places the sharp down, the other picks it up. This prevents simultaneous contact with the sharp, reducing the risk of needlestick and scalpel injuries.

A patient with known latex allergy is scheduled for surgery. What is the BEST scheduling strategy?

Schedule as the first case of the day. Latex-allergic patients should be scheduled as the FIRST case of the day. This minimizes exposure to aerosolized latex particles that accumulate in the OR air from powdered latex gloves used during earlier cases. Additionally, all latex-containing products must be removed and replaced with latex-free alternatives.

Key Takeaways

The OR fire triad consists of an ignition source, fuel, and an oxidizer (oxygen/N₂O) — all three must be present for a fire
Alcohol-based prep solutions are a major fuel source — they MUST dry completely before draping
In a fire emergency, follow RACE: Rescue, Alarm, Contain, Extinguish/Evacuate
Malignant hyperthermia (MH) is a life-threatening reaction to volatile anesthetics and succinylcholine
The treatment for MH is dantrolene sodium — every OR should have an MH cart readily available
Anaphylaxis can occur from latex, antibiotics, or anesthetic agents — epinephrine is the first-line treatment
Sharps injuries should be immediately reported and treated per OSHA bloodborne pathogen standards
The surgical technologist must know the location of fire extinguishers, MH cart, code blue cart, and emergency exits

Intraoperative Safety & Emergencies

The operating room presents unique safety hazards. The surgical technologist must be prepared to recognize and respond to emergencies quickly and correctly.

Surgical Fire Prevention

The Fire Triad — all three elements must be present for a fire:

Ignition Source: Electrocautery (Bovie), laser, fiber-optic light cords, defibrillator
Fuel: Drapes, gowns, alcohol-based prep solutions, gauze, endotracheal tubes, bowel gas, body hair
Oxidizer: Supplemental oxygen (O₂), nitrous oxide (N₂O), room air

Prevention Strategies

Ensure alcohol-based prep solutions dry completely before draping
Check for pooling of prep solution under the patient, in body folds, or in drapes
Communicate with anesthesia about oxygen concentration before activating electrocautery near the head/neck
Use wet sponges around the operative site when using electrocautery near the airway
Keep the electrosurgical pencil in a holster when not in use — never lay it on the patient
Place fiber-optic light cords on the drape (not on the patient) to prevent burns

RACE Protocol (Fire Emergency Response)

Rescue the patient (move away from fire)
Alarm — pull fire alarm, call for help
Contain the fire (close doors, use a fire extinguisher)
Extinguish/Evacuate

PASS (Fire Extinguisher Use)

Pull the pin
Aim at the base of the fire
Squeeze the handle
Sweep from side to side

Malignant Hyperthermia (MH)

Malignant hyperthermia is a rare but life-threatening pharmacogenetic reaction:

Feature	Details
Triggers	Volatile anesthetic agents (sevoflurane, desflurane, isoflurane) and succinylcholine
Pathophysiology	Uncontrolled calcium release in skeletal muscle → hypermetabolism
Early signs	Unexplained rise in end-tidal CO₂, tachycardia, muscle rigidity (especially masseter/jaw)
Late signs	Rapidly rising temperature (can reach 109°F+), hyperkalemia, metabolic acidosis, rhabdomyolysis
Treatment	Dantrolene sodium (2.5 mg/kg IV, repeat as needed) — the ONLY specific treatment
Additional treatment	Stop triggering agents, hyperventilate with 100% O₂, cool the patient, treat hyperkalemia
MH Cart	Must be available in every surgical suite — contains dantrolene, sterile water for reconstitution, cold saline

Latex Allergy & Anaphylaxis

Latex allergy ranges from contact dermatitis to life-threatening anaphylaxis
High-risk patients: healthcare workers, patients with multiple surgeries, patients with spina bifida
Anaphylaxis signs: Hypotension, bronchospasm, urticaria (hives), angioedema
Treatment: Epinephrine (first-line), remove allergen, IV fluids, corticosteroids, antihistamines
Use latex-free products for at-risk patients — schedule as the first case of the day to minimize aerosolized latex particles

Sharps Safety

Use a neutral zone (hands-free passing technique) for sharps transfer between surgeon and surgical technologist
Never hand sharps directly hand-to-hand
Place sharps in a designated zone on the Mayo stand or use a passing basin
Report all sharps injuries immediately per facility protocol and OSHA bloodborne pathogen standards

CST Certified Surgical Technologist Exam

1Introduction: CST Exam Overview

2Chapter 1: Perioperative Care — Preoperative Preparation

3Chapter 2: Perioperative Care — Intraoperative Procedures

4Chapter 3: Postoperative Procedures & Ancillary Duties

5Chapter 4: Basic Science

6Chapter 5: Exam Strategy & Practice