Local anaesthetic systemic toxicity

 

Recognise

·     CNS: seizure, coma

·     CVS: VT, VF, arrest

Call for help

·     Buzzer

Resuscitate

Seizure:

·     Midazolam 0.1mg/kg IV

·     Levetiracetam 15mg/kg IV

·     Phenytoin contraindicated

Cardiac arrest:

·     ALS protocols

·     Prolonged CPR – many people / LUCAS / ECMO

·     Intubation and hyperventilation

·     Bicarbonate 1mL/kg q2 mins (max dose?)

·     Resistance to defibrillation

·     Lignocaine contraindicated

Antidote

·     Intralipid:

o    1.5mL/kg bolus x 1-2

o    15mL/kg/h

o    Max 12mg/kg

·     Check amylase and lipase day 1 and 2