Local Anesthetic Systemic Toxicity – Is Fat The New “Wonder Drug?”

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Author: Jonathan Morgan, MSIV
Lake Erie College of Osteopathic Medicine-Bradenton

The provision of local and regional anesthesia is a core part of emergency medicine. Toxicity as a result of the administration of local anesthetics is exceedingly rare, but it does occur, and may even be more common than malignant hyperthermia.[1] Many outpatient facilities provide local or regional anesthesia and may not be prepared to handle severe toxicity. Emergency physicians should be prepared to deal with this rare but catastrophic outcome if it occurs following anesthesia either in their own department or in another setting.

Local Anesthesia Systemic Toxicity

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Local anesthetic systemic toxicity (LAST) can result from administration of any of the local anesthetics and can be difficult to identify. Classic descriptions include CNS toxicity (altered mental status, agitation, sedation, or seizures) preceding respiratory or cardiac arrest, but the presentation can be quite variable and the first symptom of LAST may be cardiac arrest. Symptoms may appear within a minute, but can also appear more than 5 minutes after injection of an anesthetic. There is a classic prodrome of auditory changes and metallic taste, but one review found that this was present in less than 20% of cases.[2,3]

Hepatic Encephalopathy Meets the ED

Image credit: Tareq Salahuddin

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Author: Alfred Morrobel, MS3
Medical Student
Universidad Iberoamericana

Introduction & Pathophysiology 
Hepatic encephalopathy (HE), also known as portosystemic encephalopathy, is a potentially deadly complication of chronic liver failure. HE is commonly caused by liver failure due to cirrhosis, but there are non-cirrhotic causes as well. Cirrhosis is commonly caused by alcohol abuse and hepatitis B & C, each of which contribute to chronic liver scarring.[1] Symptoms are similar regardless of the underlying etiology. The basis of hepatic encephalopathy is ammonia accumulation in the brain, which produces drastic motor and cognitive impairment.[3] HE results in a constellation of neurological problems that includes chronic fatigue, difficulty thinking, forgetfulness, asterixis, poor judgment, excessive confusion, disorientation, personality changes, and hyperactive deep tendon reflexes.[2] Patients with HE may also demonstrate stigmata of chronic liver disease: jaundice, ascites, peripheral edema, telangiectasias, caput medusae, and palmar erythema. In general, physicians use scoring systems, such as the West Haven Criteria, when diagnosing HE because of the variety of symptoms HE can cause in any individual patient. The criteria depend on the severity of the patients’ clinical symptoms, whether they are cognitive, motor, or both (see summary in table 1). [2,4]

Emergency Medicine Match: 2015 Results

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Author: Muhammad Alghanem, DO
Midwestern University - Chicago College of Osteopathic Medicine

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Congratulations to all the medical school seniors and graduates who matched into emergency medicine in 2015 and good luck to the upcoming 2016 applicants! Both NRMP [1] and AOA [2] news releases reflect on the growth of the matches this year. In this short post, we will discuss some of the results available for the 2015 allopathic and osteopathic emergency medicine matches.