• Guidelines - management of LA toxicity
    Link:www.aagbi.org/sites/default/files/la_toxicity_2010_0.pdf
    • Signs
      • Alteration in mental status
      • Convulsions
      • CV collapse
        • Arrhythmias
        • Sinus bradycardia
        • Asystole
        • VT
    • Management
      • Immediate management
        • Stop injecting
        • Call for help
        • Maintain airway and give 100% O₂. Consider intubation and hyperventilation
        • Control seizures
          • Benzodiazepine, propofol or thiopentone
        • Start CPR if circulatory arrest
      • Give bolus of 1.5ml/kg of 20% intra lipid over 1 min ~ 100ml
      • Start infusion of 15ml/kg/hr ~ 1000ml/hr
      • Repeat boluses after 5 mins to maximum of two repeat boluses
      • Double the infusion rate to 30ml/kg/hr if after 5 mins CV stability has not returned or if an adequate circulation deteriorates
      • Do not exceed a maximum cumulative dose of 12ml/kg ~ 840ml