The “LAST” was shared on the Internet

The “LAST” was shared on the Internet

The “LAST” was shared on the Internet, today.
The Pharmacologic Treatment of Local Anesthetic Systemic Toxicity (LAST) is Different from Other Cardiac Arrest Scenarios
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Initial Focus
Airway management: ventilate with 100% oxygen
Seizure suppression: benzodiazepines are preferred;AVOID propofol in patients having signs of cardiovascular instability
Alert the nearest facility having cardiopulmonary bypass capability
Management of Cardiac Arrhythmias
Basic and Advanced Cardiac Life Support (ACLS) will require adjustment of medications and perhaps prolonged effort
AVOID vasopressin, calcium channel blockers, beta blockers, or local anesthetic
REDUCE individual epinephrine doses to <1 mcg/kg Lipid Emulsion (20%) Therapy (values in parenthesis are for 70kg patient) Bolus 1.5 mL/kg (lean body mass) intravenously over 1 minute (~100mL) Continuous infusion 0.25 mL/kg/min (~18 mL/min; adjust by roller clamp) Repeat bolus once or twice for persistent cardiovascular collapse Double the infusion rate to 0.5 mL/kg/min if blood pressure remains low Continue infusion for at least 10 minutes after attaining circulatory stability Recommended upper limit: Approximately 10 mL/kg lipid emulsion over the first 30 minutes. Post LAST events at www.lipidrescue.org Download the full printable checklist (From on the Internet). Abstract In the world, in the techniques of the brachial nerve plexus block - one of the best technique had avoided not only a phrenic nerve but also the ulnar, radial, median, musculocutaneous nerves & "LAST" - That is our new interscalene block which we have not been using both an ultrasound guidance and a peripheral nerve stimulator in our new technique, in Vietnam today. Kim Nguyen

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