This is EM Case's EM Quick Hits podcast, where our team of experts and educators bring

a clear, concise, and condensed, practice-changing knowledge on all those EM topics you

may not be totally comfortable with.

Cases, the latest evidence, procedural tips and tricks, pitfalls to avoid, and the key take-home

points and references on the EM cases website.

Quick, let's get on with it.

EM cases is part of Shremi, the Schwartz-Riseman Emergency Medicine Institute.

That's the nonprofit organization dedicated to improving EM care through high-quality research and education. The opinions expressed on this podcast are intended for general information and educational purposes only and should not be used to diagnose treat or prevent any medical condition, nor should they be used as a substitute for medical advice from qualified practicing physician. Unless stated otherwise, the opinions expressed by the hosts or guests are made in their individual capacity, not on behalf of the Institute nor Medicine cases. We're going to start off with a pair of talks quick hits. The first with Swami on last,

that's local anesthetic systemic toxicity, a totally preventable, life-threatening, iatrogenic, acute

neurologic cardiac catastrophe. And then we'll hear from Emily Austin.

We use local anesthetics almost every shift that we work in the emergency room.

And I think sometimes when we have that frequent of an exposure to a medication,

we don't always think about the harms, about the downsides, about the possible toxicity of the

medication.

Acidaminopin is another one that we use all the time.

And honestly, in the doses that we're using, we don't really worry too much about toxicity caused

by us. But with the local anesthetics, we really can have iatrogenic harm. So what I wanted to

talk about is local anesthetic systemic toxicity or Las Syndrome. This is a life-threatening,

adverse reaction resulting from local anesthetic reaching significant systemic circulating levels. Last is pretty rare. It occurs within minutes of

injection of the local anesthetic, so we don't really see these delayed problems. There are a

number of different ways that this can happen. The common ones are when

there's purposeful injection of local anesthetic into the systemic circulation, either errantly

...