AANA journal
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Local anesthetic toxicity can have catastrophic outcome in an otherwise benign procedure. Introduction of even a small amount of local anesthetic into the bloodstream can cause cardiac arrest in a healthy patient. Most healthcare facilities rely on standard resuscitative techniques to treat such events; however, treatment via infusion of lipid emulsion has been used successfully to stabilize the condition of some patients in a safe, effective, and rapid manner. ⋯ The key words included in the search were "Intralipid," "local anesthetic toxicity," "lipid infusion," and "lipid sink." Lipid therapy has shown great promise for the treatment of patients facing cardiovascular collapse due to local anesthetic toxicity. However, the slow adoption of this novel evidence-based practice by healthcare facilities endangers patients who may not receive the best available care when the need is most dire. Current evidence suggests that infusion of lipid emulsion should be considered among the primary treatments for local anesthetic toxicity and be made readily available in every facility's operating or procedure room, and hospital staff should be trained in its use when local anesthetic toxicity is suspected.
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Nearly one-fourth of all trauma admissions present in varying degrees of coagulopathy. According to a US study, 40% of trauma fatalities are due to hemorrhage and hemorrhagic shock, and nearly all patients who are alive when they reach the hospital are coagulopathic when they die. ⋯ Because of the clinical significance of trauma-induced coagulopathy, management strategies to reduce the morbidity and mortality have recently become of interest. This article will review the pathology of trauma-induced coagulopathy and current trends in management, as well as closely examine the data surrounding the use of recombinant factor VII for the treatment of trauma-induced coagulopathy.