LAST: The Lipid Rescue Protocol
Local Anesthetic Systemic Toxicity is a rare but lethal complication. Master the immediate steps and the 'Why' behind them.
LAST: When the Block Goes Systemic
You’ve probably seen a smooth regional block turn into a nightmare in seconds. Seziures, then bradycardia, then asystole. The reality is, LAST management is fundamentally different from standard ACLS.
The Cliff: The Epinephrine Trap
In standard ACLS, we give 1mg of Epi. In a LAST cardiac arrest, high doses of Epi actually hinder the effectiveness of the lipid emulsion and can worsen arrhythmias. "I will limit Epinephrine doses to less than 1 mcg/kg and avoid vasopressin, as these can impede resuscitation in the setting of local anesthetic toxicity."
The Pivot: Intralipid 20%
The "Lipid Sink" is your lifeline. "I will immediately bolus 1.5 mL/kg of 20% Lipid Emulsion, followed by an infusion at 0.25 mL/kg/min. I will continue resuscitation for at least 60 minutes, as recovery from LAST can be prolonged."
Conclusion: Knowledge is the Antidote
On the boards, stating "I'll call for help" isn't enough. You must lead the code. Use the Oral Boards Bot to practice calling out the specific lipid doses under pressure.