Credits to Michael Garchitorena, RN IV for this OR mock/simulation presented at the Medical Surgical Center.

The simulation begins with the patient in the OR bed supine. He has received a local anesthetic (digital nerve block) bupivacaine0.25% mixed with lidocaine1% plain for intraoperative pain control from attending surgeon.

The surgical team (SURGEON, RN CIRCULATOR, SCRUB, ANESTHESIA (ATTENDING ,CRNA) is present.
The RN circulator is preparing to prep, the surgeon and scrub are ready to drape.

Pt vital sign is stable B/P-110/70; HR- 72; O2 saturation is 100%

Within 3 mins after draping. Pt was exhibiting agitation, feeling confused and murmuring. (unable to understand) anesthesia continue asses pt., the patient displays seizure activity and the Ecg show ventricular tachycardia (HR 150) with the bp jumping to 150/90.the anesthesia administer benzodiazepine for seizure and the seizure subsequently stop. The anesthesia suspect LAST toxicity as it was the only drug was given.

The patient then progress to hemodynamic depression…as the b/p drops to 90/40 with downward trend to 80/40 the 75/35 to 70/30 with saturation to 60%.the ECG shows ventricular fibrillation. And cardiac arrest.

Anesthesia asses the patient, and secure airway. O2 to 100% (or intubation initiated) CPR and proceed with 20 % lipid emulsion iv first bolus and followed with continuous infusion . stabilized pt. and transfer to icu for observation.

---

Designated roles:

RN CIRCULATOR- CRISIS LEADER; ROLE ASSIGN AND DELEGATE TASK.RECORDER

RN1- CRASH CART (HELP CPR IF LEAD TO CARDIAC ARREST)
RN2- LAST KIT PYXIS (HALLWAY OUTSIDE OR2 AND OR7)-COULD ASSIST

PREPARING MEDS FOR BOLUS.
EXTRA ANESTHESIA TEAM (PROVIDER, CRNA, RN FOR IV ACCESS)

CHARGE RN-INFORMED ATTENDING; PHARMACIST FOR EMERCENCY MEDICAL SITUATION; GATHER HELP

ANESTHESIA TECH- INTUBATION ANTICIPATION; ASSIST ANESTHESIA IV PUMP;IV ACCESS SUPPLY.IV SUPPLY FOR LIPID EMULSION BOLUS AND INFUSION.TRANSFER PT.

SURGEON-stop local anesthetic medication. Abort procedure or pack wound if necessary. NOTIFY FAMILY

SCRUB-Maintain sterile field assist surgeon undraping.

Expand your 5 minute read

What is local anesthetic systemic toxicity?

Local anesthetic systemic toxicity (LAST) is a rare, life-threatening complication of receiving local anesthetic medications. LAST typically causes issues with your central nervous system and/or cardiovascular system, like seizures and arrhythmias.

Local anesthetics work by temporarily blocking your peripheral nerves from sending pain and sensory signals to your brain. Healthcare providers use these medications to numb specific areas of your body for various procedures. Local anesthetics come in many forms, like injections, gels and sprays. In rare cases, local anesthetics can cause toxicity within minutes of receiving them. read more.

Names, dates, and personal identifying details have been changed throughout this website to comply with the Health Insurance Portability and Accountability Act (HIPAA). This post is for educational and informational purposes only. The clinical scenario is illustrative, not a verified patient history.**