BACK to BASICS
LAST is short for this toxicity?
What is Local Anesthetic Systemic Toxicity?
These 2 patient populations are at greatest risk for last
Who are the elderly and neonates>
The very first action when LAST is suspected.
What is stopping the local anesthetic administration?
What is metallic?
This technique helps avoid intravascular injection.
What is aspiration before injection?
Last can occur from____seconds to ____minutes after injection?
what is 30 seconds to 60 minutes
Accidental injection into this structure rapidly increases systemic levels.
What is a blood vessel?
Which property of local anesthetics (think solubility) determines CNS toxicity?
What is lipid solubility?
This auditory symptom often precedes seizures.
What is tinnitus?
Hypertension and tachycardia are observed in this phase of LAST?
What is initial?
LAST targets this body system first?
What is the central nervous system?
These 3 comorbidities increase the risk of LAST?
What is renal, hepatic and cardiac?
This medication class is preferred for LAST‑induced seizures.
What are benzodiazepines?
This serious neurologic complication may occur if LAST progresses
What are seizures?
A toxic dose of local anesthetic will interfere with this function and these pathways that regulate ion flow.
What is inotropic and NA, K and CL?
This is prioritized before medications in LAST management.
What is airway and oxygenation?
This ECG change may indicate sodium channel blockade.
What is QRS widening?
This is the maximum recommended total dose of Lipid emulsion therapy.
What is 12ml/kg
Loss of consciousness and airway compromise require this immediate intervention.
What is airway management?
During resuscitation of a patient with suspected LAST, ventricular arrhythmias persist despite high‑quality CPR. Which ACLS medication should be used cautiously or avoided at high doses because it can worsen local anesthetic cardiotoxicity?
What is epinephrine (high doses)
Which symptom indicates progression from CNS to cardiovascular toxicity.
What is bradycardia or cardiac arrest?
This anesthetic is most associated with cardiac arrest in LAST.
What is bupivacaine?
This anesthetic agent presents the highest risk for LAST.
What is Bupivacaine?
A 68‑year‑old patient receives a peripheral nerve block for postoperative pain. Minutes later, they report a metallic taste and ringing in their ears, become increasingly agitated, and then develop a generalized seizure followed by hypotension and a wide‑complex rhythm on the monitor. Based on this presentation, what life‑saving therapy must be initiated immediately according to LAST management guidelines?
What is 20% lipid emulsion therapy?
A patient receives a local anesthetic for a bedside procedure. The full dose is injected rapidly without intermittent aspiration. Continuous cardiac monitoring is not in place, and lipid emulsion therapy is not immediately available on the unit. Within minutes, the patient develops tinnitus, seizures, and cardiovascular collapse.
From a root‑cause perspective, what key failure most directly contributed to the development and severity of this event?
What is failure to follow LAST prevention protocols (incremental dosing, aspiration, monitoring, and preparedness)?