LAST

Question 1

LAST symptoms

Answer 1

• Analgesia
• Lightheadedness
• Tinnitis
• Tongue/circumoral numbness/ tingling/funny taste
• Seizures
• Unconsciousness
• Respiratory arrest
• Cardiovascular arrest

Question 2

Steps for lipid rescue for LAST:

Answer 2

• Bolus intralipid 20% IV 1.5mL/kg over 1 min
• Intralipid infusion 0.25mL/kg/min
• Continue CPR to circulate lipids

Question 3

How often can you repeat intralipid bolus?

Answer 3

Repeat bolus q3-5 min up to 3mL/kg total dose until circulation is restored

Question 4

How long to continue intralipid infusion?

Answer 4

• Increase infusion to 0.5mL/kg/min if BP declines
• Continue infusion until hemodynamically stable

Question 5

What is the max total dose of lipids?

Answer 5

10mL/kg

Question 6

What can cause LAST?

Answer 6

Excess plasma concentration of drug

Question 7

What are predisposing risk factors for LAST CV effects?

Answer 7

• Pregnancy: Lower plasma esterases
• Hepatic and renal disease
• Arterial hypoxemia, acidosis, or hypercarbia
• Beta blockers
• Digitalis
• Calcium channel blockers
• Epi and phenylephrine use

Question 8

How are seizures from LAST treated?

Answer 8

• Supplemental O2
• Benzos (versed or valium)
• Propofol if stable
• Muscle relaxant (Succs or NDMR)
• Intralipid emulsion

Question 9

How does LAST resuscitation differ from standard ACLS?

Answer 9

• Avoid: LA, beta blockers, CCBs, Vaso
• Smaller than normal epi doses

Question 10

What are dose dependent effects of lidocaine?

Answer 10