*

Catherine Reid, MD

12/14/12

* Initial symptoms: tongue/oral numbness, tinnitus,

dizziness, blurred vision, restlessness * CNS signs/symptoms:

* Initial excitation: restlessness, agitation,

* Cardiovascular signs/symptoms: hypotension, AV

block, ventricular arrythmias (Vtach, Vfib), circulatory arrest

nervousness, paranoia, hallucinations * Subsequent depression: slurred speech, drowsiness, unconsciousness * Ultimately tonic-clonic seizures

Agent

Duration (min) 30-60 45-90 200+ 200+ 200

Onset (min) 5 3 10-15 5-15 15

Toxic Dose (mg/kg) 3.5 4 3 3 1.5

Toxic Dose with Epinephrine (mg/kg) 7 3.5-5

Lidocaine Mepivacaine Bupivacaine Ropivacaine Tetracaine

Intravenous Injection

>

Tracheal Injection > Intercostal Injection > Epidural Injection > Brachial Plexus Injection > Peripheral Nerve Injection > Subcutaneous Injection

* CALL FOR HELP! * ACLS Protocol for cardiopulmonary support * Administer IntraLipid (where is it?)
* 1.5 ml/kg bolus of 20% solution over 1 minute * 0.25 ml/kg/min infusion of 20% solution * Bolus may be repeated every 3-5 minutes until
return of spontaneous circulation

* Max dose: 8 ml/kg

*Check to ensure proper administration rate *Open white clamp; watch to ensure local
anesthetic infusing from end of tubing catheter

*Connect tubing to peripheral nerve block *If you have any concerns about the patient
DISCONNECT IMMEDIATELY AND CALL MD!