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Yea I’ve only ever heard of it being an issue in kids. Toxic dose of lidocaine for a normal 70kg adult would be quite impressive.
Another way to look at the problem with our “specialty”
Started by zurned
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The only time it's really a thing is when plastics uses it for tumescent
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Basically they put a bunch of lido in a bunch of fluid and inject it all through the sq for the belly. Usually for women, not men.
Yea who the fock knows.
I remember as an intern I was calculating the dose of lidocaine toxicity before using it -- and my attending asked me what the hell I was doing. I told him and he said, "you can give the whole damn thing."
That stuck with me. If you have to use more than one damn thing, then think about it.
That stuck with me. If you have to use more than one damn thing, then think about it.
I propose using "one damn thing" as a standardized unit of measurement.
I've used more than one vial of lidocaine before. It's pretty rare...one standard vial of 1% is 20 ml which is usually plenty...and once you do the math it's under 4 ml / kg or whatever it is. But sometimes some has like 2-3 feet of various lacerations on their arms or legs and I'm pumping it full of lidocaine.
Maybe in those cases it's just better to use ketamine and knock them out...but there is so much rigmarole in doing conscious sedation in the ED
Maybe in those cases it's just better to use ketamine and knock them out...but there is so much rigmarole in doing conscious sedation in the ED
Yeah at that point, it’s time for me to call surgery/trauma and let them take the patient to the OR. Never get any pushback for that.
What percentage of patients can be really dealt with by regular old Registered Nurses? You dont even need a mid-level? How about LPN?
Peope NEED to see physicians. Plain and simple.
I fixed it for you
So, this happened to me at like 3:47 AM one morning not that long ago.
Police bring in suspect after foot pursuit thru bushes, etc. The police K-9 took down the suspect, stopping the pursuit.
Cops bring in Homeboy McHomeyson. His extremities are full of lacerations from both brush and doggo.
I'm surveying these wounds, and I'm thinking: "Okay, this is going to take me quite the long time to suture up - and gen.surg is going to throw a pediatric tantrum if I call them to come clean up this guy only to release him to police custody. Guess I'll just suck it up and get it done."
At some point after leaving the room, my brain (jokingly, so as to not confuse those on here who will trip all over themselves on their way to being offended) came up with:
"I mean; could they not just have shot the guy? You know, like, in the leg? It would have been cleaner, easier, faster... all those things."
Lulz.
To be clear: in no way am I advocating for the police to just have opened fire on him. But it would have been easier to clean up and close one simple wound rather than eleventeen of them.
Depending on how many lacs there were, I'd just sedate the guy with ketamine. You could justify it in your chart by how you might hit lido toxicity if done normally. If you're looking at 11+ decent sized lacs, not having to numb each and every one is going to be way faster, even factoring in the time requirements of the sedation.
I know it's just early morning musing, brother, but, the reality is that, if you shoot a perp, and he doesn't become inert (unconscious/dead), it's possible/likely he'll become more aggressive and violent, not pacified. The general public (less educated and intelligent as you) parrot that - "why didn't they shoot him in the leg?", without any idea of the reality of violent criminals.
It's now several years ago, but Dr.McNinja used the term "Mozambique Drill", like it was simple, common knowledge. MUCH more clearly, that is the "two to the chest, 1 to the head". You need to incapacitate the perp, not hobble him.
Oh man I usually get push back. It's terrible.
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Yup also running sutures or staples are a must in those situations. Sooo much faster.
Oh, I get it.
That was just the way my brain drew it up in the wee hours of the morning; like a part of script from say, an episode of "Arrested Development" or "Rick and Morty". I knew instantly: "That... that's not how that works, RustedFox... that's not how that works. Don't say that. Don'tsaythat."
Staples for the win.
Exactly. I don't worry about cosmetics closures on drunks and prisoners. Staple what I can, suture what I must, and leave open the small stuff.
Just steristrip him and send him on his way
If it's a face, I'll suture it. If it's an extremity... well, have you seen the number of hip and knee replacements that they staple together these days?
Yep - it's not about the identity of the patient, it's about the nature and location of the laceration.
I'll do runnings or staples on a plastic surgeon's leg lac if it's appropriate - they can always get it revised as an outpatient.
Honestly for any normal sized adult this is my metric. If you need more than a whole bottle of lidocaine, maybe the patient is better served going to the OR or at least having the procedure done with sedation instead of a ****load of local.
I used two large staple guns on a little old lady who managed to deglove her whole calf (a big floppy L shaped lac) on a milk crate once. That's two damn things, I guess, but I was an attending by then so I just told the tech to get me another. It still took awhile. I don't remember how much lido; I might have just sedated her though. Little old ladies tend up be tough and it was the superficial fat that just sheared with the skin but one hell of a laceration.
Police-dog deglovings get surgery. Only been "privileged" to deal with one of those and that was back in residency. That's a whole other degree of nastiness that needs washing out.
But my favorite big honking abscess story? (To get us back on the first derailing...)
Little old guy comes in, tells me he went to sit on the pot that morning and SPLOOSH, all this goo came out of his chest where his pacemaker was.
Sure enough, there was at least another cupful of puss in the pacer pocket, and you could read the brand of the device by just looking at it. Yeah, that's a problem.
Police-dog deglovings get surgery. Only been "privileged" to deal with one of those and that was back in residency. That's a whole other degree of nastiness that needs washing out.
But my favorite big honking abscess story? (To get us back on the first derailing...)
Little old guy comes in, tells me he went to sit on the pot that morning and SPLOOSH, all this goo came out of his chest where his pacemaker was.
Sure enough, there was at least another cupful of puss in the pacer pocket, and you could read the brand of the device by just looking at it. Yeah, that's a problem.
