Local anaesthetic toxicity: are we prepared for the consequences in the Emergency Department?
BackgroundLocal anaesthetic agents are commonly encountered in the Emergency Department (ED). Local anaesthetic toxicity leading to cardiorespiratory arrest is a rare, but potentially fatal, complication of an overdose of these agents. A recent innovation in the treatment of severe local anaesthetic...
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| Veröffentlicht in: | Emergency medicine journal : EMJ 2010-08, Vol.27 (8), p.599-602 |
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| description | BackgroundLocal anaesthetic agents are commonly encountered in the Emergency Department (ED). Local anaesthetic toxicity leading to cardiorespiratory arrest is a rare, but potentially fatal, complication of an overdose of these agents. A recent innovation in the treatment of severe local anaesthetic toxicity has been the introduction of intravenous lipid emulsion therapy (Intralipid® 20%). The aim of this study was to gauge the current level of knowledge surrounding the administration and complications associated with commonly used local anaesthetic agents.MethodsQuestionnaires were distributed amongst the training grade doctors working in four Emergency Departments. Results were divided into two groups for ease of analysis. Core Trainees (CT) and Foundation Year 2 (F2) doctors were placed in one group. Specialist Registrars (SPR), Speciality Registrars (StR) and Staff Grades (SG) form the other group.ResultsThe results showed that less than half of the CT/F2 group knew the maximum dose of lignocaine 1%. 80% of these doctors were unable to calculate the maximum dose of lignocaine 1% for an 80 kg man, and nearly one-third would administer a toxic dose. In addition, only one out of 30 in the CT/F2 group were aware of lipid emulsion therapy.ConclusionsThose using local anaesthetic should also be able to recognise the signs and symptoms of toxicity should this occur and act accordingly. The lack of knowledge amongst the more junior staff, as demonstrated by this project, highlights failings in teaching the basics of safe practices in the ED. |
| doi_str_mv | 10.1136/emj.2009.079038 |
| format | Article |
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Local anaesthetic toxicity leading to cardiorespiratory arrest is a rare, but potentially fatal, complication of an overdose of these agents. A recent innovation in the treatment of severe local anaesthetic toxicity has been the introduction of intravenous lipid emulsion therapy (Intralipid® 20%). The aim of this study was to gauge the current level of knowledge surrounding the administration and complications associated with commonly used local anaesthetic agents.MethodsQuestionnaires were distributed amongst the training grade doctors working in four Emergency Departments. Results were divided into two groups for ease of analysis. Core Trainees (CT) and Foundation Year 2 (F2) doctors were placed in one group. Specialist Registrars (SPR), Speciality Registrars (StR) and Staff Grades (SG) form the other group.ResultsThe results showed that less than half of the CT/F2 group knew the maximum dose of lignocaine 1%. 80% of these doctors were unable to calculate the maximum dose of lignocaine 1% for an 80 kg man, and nearly one-third would administer a toxic dose. In addition, only one out of 30 in the CT/F2 group were aware of lipid emulsion therapy.ConclusionsThose using local anaesthetic should also be able to recognise the signs and symptoms of toxicity should this occur and act accordingly. The lack of knowledge amongst the more junior staff, as demonstrated by this project, highlights failings in teaching the basics of safe practices in the ED.</description><identifier>ISSN: 1472-0205</identifier><identifier>EISSN: 1472-0213</identifier><identifier>DOI: 10.1136/emj.2009.079038</identifier><identifier>PMID: 20688937</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine</publisher><subject>Anesthesiology - education ; Anesthetics, Local - administration & dosage ; Anesthetics, Local - adverse effects ; Cardiac arrest ; Clinical Competence ; Drug dosages ; Education ; Education, Medical, Continuing ; emergency care systems ; emergency departments ; Emergency medical care ; Emergency Service, Hospital - standards ; Heart Arrest - chemically induced ; Heart Arrest - therapy ; Humans ; Internship and Residency ; Knowledge ; Lidocaine - administration & dosage ; Lidocaine - adverse effects ; lipid emulsion ; Lipids ; local anaesthetic ; Medical Staff, Hospital ; Physicians ; Prescription Drug Misuse ; Regional anesthesia ; Surveys and Questionnaires ; Teaching hospitals ; Toxicity ; United Kingdom</subject><ispartof>Emergency medicine journal : EMJ, 2010-08, Vol.27 (8), p.599-602</ispartof><rights>2010, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><rights>Copyright: 2010 (c) 2010, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b397t-5a0c15241c3be46480088f2a0896c6f7d36dc9ea13636afa93353d9648e0f10b3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://emj.bmj.com/content/27/8/599.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://emj.bmj.com/content/27/8/599.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,315,781,785,3197,23576,27929,27930,77605,77636</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20688937$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cooper, B R</creatorcontrib><creatorcontrib>Moll, T</creatorcontrib><creatorcontrib>Griffiths, J R</creatorcontrib><title>Local anaesthetic toxicity: are we prepared for the consequences in the Emergency Department?</title><title>Emergency medicine journal : EMJ</title><addtitle>Emerg Med J</addtitle><description>BackgroundLocal anaesthetic agents are commonly encountered in the Emergency Department (ED). Local anaesthetic toxicity leading to cardiorespiratory arrest is a rare, but potentially fatal, complication of an overdose of these agents. A recent innovation in the treatment of severe local anaesthetic toxicity has been the introduction of intravenous lipid emulsion therapy (Intralipid® 20%). The aim of this study was to gauge the current level of knowledge surrounding the administration and complications associated with commonly used local anaesthetic agents.MethodsQuestionnaires were distributed amongst the training grade doctors working in four Emergency Departments. Results were divided into two groups for ease of analysis. Core Trainees (CT) and Foundation Year 2 (F2) doctors were placed in one group. Specialist Registrars (SPR), Speciality Registrars (StR) and Staff Grades (SG) form the other group.ResultsThe results showed that less than half of the CT/F2 group knew the maximum dose of lignocaine 1%. 80% of these doctors were unable to calculate the maximum dose of lignocaine 1% for an 80 kg man, and nearly one-third would administer a toxic dose. In addition, only one out of 30 in the CT/F2 group were aware of lipid emulsion therapy.ConclusionsThose using local anaesthetic should also be able to recognise the signs and symptoms of toxicity should this occur and act accordingly. The lack of knowledge amongst the more junior staff, as demonstrated by this project, highlights failings in teaching the basics of safe practices in the ED.</description><subject>Anesthesiology - education</subject><subject>Anesthetics, Local - administration & dosage</subject><subject>Anesthetics, Local - adverse effects</subject><subject>Cardiac arrest</subject><subject>Clinical Competence</subject><subject>Drug dosages</subject><subject>Education</subject><subject>Education, Medical, Continuing</subject><subject>emergency care systems</subject><subject>emergency departments</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital - standards</subject><subject>Heart Arrest - chemically induced</subject><subject>Heart Arrest - therapy</subject><subject>Humans</subject><subject>Internship and Residency</subject><subject>Knowledge</subject><subject>Lidocaine - administration & dosage</subject><subject>Lidocaine - adverse effects</subject><subject>lipid emulsion</subject><subject>Lipids</subject><subject>local anaesthetic</subject><subject>Medical Staff, Hospital</subject><subject>Physicians</subject><subject>Prescription Drug Misuse</subject><subject>Regional anesthesia</subject><subject>Surveys and Questionnaires</subject><subject>Teaching hospitals</subject><subject>Toxicity</subject><subject>United Kingdom</subject><issn>1472-0205</issn><issn>1472-0213</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNqFkE1v1DAQhi1ERUvh3BuyxKESUrbjOP7igqqlpZVWIKHCrbIcZ9Jm2SSL7RXdf4-3KXvohZNH48fzjh9CThjMGOPyDPvlrAQwM1AGuH5BjlilygJKxl_uaxCH5HWMSwAmTKVfkcMSpNaGqyNyuxi9W1E3OIzpHlPnaRofOt-l7UfqAtI_SNcB17lsaDsGmiHqxyHi7w0OHiPthsfeRY_hLne29POOTj0O6dMbctC6VcS3T-cx-XF5cTO_KhbfvlzPzxdFzY1KhXDgmSgr5nmNlaw0gNZt6UAb6WWrGi4bb9DlH3PpWmc4F7wxGURoGdT8mJxOc9dhzHvFZPsuelyt3IDjJlpVaSOEBpnJ98_I5bgJQ17OMpVzjWFqR51NlA9jjAFbuw5d78LWMrA78TaLtzvxdhKfX7x7mrupe2z2_D_TGSgmoIsJH_b3LvyyUnEl7Nefc3sjpBLGfLcs8x8mvs5J_0v_CyeNmXs</recordid><startdate>201008</startdate><enddate>201008</enddate><creator>Cooper, B R</creator><creator>Moll, T</creator><creator>Griffiths, J R</creator><general>BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine</general><general>BMJ Publishing Group LTD</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RQ</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>201008</creationdate><title>Local anaesthetic toxicity: are we prepared for the consequences in the Emergency Department?</title><author>Cooper, B R ; Moll, T ; Griffiths, J R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b397t-5a0c15241c3be46480088f2a0896c6f7d36dc9ea13636afa93353d9648e0f10b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Anesthesiology - education</topic><topic>Anesthetics, Local - administration & dosage</topic><topic>Anesthetics, Local - adverse effects</topic><topic>Cardiac arrest</topic><topic>Clinical Competence</topic><topic>Drug dosages</topic><topic>Education</topic><topic>Education, Medical, Continuing</topic><topic>emergency care systems</topic><topic>emergency departments</topic><topic>Emergency medical care</topic><topic>Emergency Service, Hospital - standards</topic><topic>Heart Arrest - chemically induced</topic><topic>Heart Arrest - therapy</topic><topic>Humans</topic><topic>Internship and Residency</topic><topic>Knowledge</topic><topic>Lidocaine - administration & dosage</topic><topic>Lidocaine - adverse effects</topic><topic>lipid emulsion</topic><topic>Lipids</topic><topic>local anaesthetic</topic><topic>Medical Staff, Hospital</topic><topic>Physicians</topic><topic>Prescription Drug Misuse</topic><topic>Regional anesthesia</topic><topic>Surveys and Questionnaires</topic><topic>Teaching hospitals</topic><topic>Toxicity</topic><topic>United Kingdom</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cooper, B R</creatorcontrib><creatorcontrib>Moll, T</creatorcontrib><creatorcontrib>Griffiths, J R</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Career & Technical Education Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Emergency medicine journal : EMJ</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cooper, B R</au><au>Moll, T</au><au>Griffiths, J R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Local anaesthetic toxicity: are we prepared for the consequences in the Emergency Department?</atitle><jtitle>Emergency medicine journal : EMJ</jtitle><addtitle>Emerg Med J</addtitle><date>2010-08</date><risdate>2010</risdate><volume>27</volume><issue>8</issue><spage>599</spage><epage>602</epage><pages>599-602</pages><issn>1472-0205</issn><eissn>1472-0213</eissn><abstract>BackgroundLocal anaesthetic agents are commonly encountered in the Emergency Department (ED). Local anaesthetic toxicity leading to cardiorespiratory arrest is a rare, but potentially fatal, complication of an overdose of these agents. A recent innovation in the treatment of severe local anaesthetic toxicity has been the introduction of intravenous lipid emulsion therapy (Intralipid® 20%). The aim of this study was to gauge the current level of knowledge surrounding the administration and complications associated with commonly used local anaesthetic agents.MethodsQuestionnaires were distributed amongst the training grade doctors working in four Emergency Departments. Results were divided into two groups for ease of analysis. Core Trainees (CT) and Foundation Year 2 (F2) doctors were placed in one group. Specialist Registrars (SPR), Speciality Registrars (StR) and Staff Grades (SG) form the other group.ResultsThe results showed that less than half of the CT/F2 group knew the maximum dose of lignocaine 1%. 80% of these doctors were unable to calculate the maximum dose of lignocaine 1% for an 80 kg man, and nearly one-third would administer a toxic dose. In addition, only one out of 30 in the CT/F2 group were aware of lipid emulsion therapy.ConclusionsThose using local anaesthetic should also be able to recognise the signs and symptoms of toxicity should this occur and act accordingly. The lack of knowledge amongst the more junior staff, as demonstrated by this project, highlights failings in teaching the basics of safe practices in the ED.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine</pub><pmid>20688937</pmid><doi>10.1136/emj.2009.079038</doi><tpages>4</tpages></addata></record> |
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| ispartof | Emergency medicine journal : EMJ, 2010-08, Vol.27 (8), p.599-602 |
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| subjects | Anesthesiology - education Anesthetics, Local - administration & dosage Anesthetics, Local - adverse effects Cardiac arrest Clinical Competence Drug dosages Education Education, Medical, Continuing emergency care systems emergency departments Emergency medical care Emergency Service, Hospital - standards Heart Arrest - chemically induced Heart Arrest - therapy Humans Internship and Residency Knowledge Lidocaine - administration & dosage Lidocaine - adverse effects lipid emulsion Lipids local anaesthetic Medical Staff, Hospital Physicians Prescription Drug Misuse Regional anesthesia Surveys and Questionnaires Teaching hospitals Toxicity United Kingdom |
| title | Local anaesthetic toxicity: are we prepared for the consequences in the Emergency Department? |
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