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Lidocaine Toxicity During Attempted Epistaxis Cautery.
Elizabeth Nicholas1, Matthew D Thornton1
1Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, New York.
The Journal of Emergency Medicine
|July 3, 2016
Summary
Topical lidocaine, commonly used for nosebleeds, can cause severe toxicity. Emergency physicians must recognize and manage this risk, which can manifest as seizures and bradycardia, even with intranasal application.
Area of Science:
- Emergency Medicine
- Pharmacology
Background:
- Epistaxis affects up to 60% of the population and is a frequent emergency department complaint.
- Topical lidocaine is often used for analgesia during intranasal cauterization for refractory epistaxis.
- Lidocaine is generally considered safe, but carries potential risks.
Observation:
- A 19-year-old male presented with persistent anterior epistaxis.
- The patient developed severe lidocaine toxicity, including seizures, bradycardia, and hypotension, after topical intranasal anesthesia.
- Symptoms were rapidly recognized and treated, leading to a positive patient outcome.
Findings:
- Topical intranasal lidocaine can lead to systemic toxicity.
- Lidocaine toxicity presents with neurological and cardiovascular symptoms.
- Prompt recognition and management are crucial for favorable outcomes.
Implications:
- Emergency physicians must be aware of potential lidocaine toxicity from intranasal use.
- This case highlights the importance of considering lidocaine's risks even in common procedures.
- Understanding lidocaine toxicity's pathophysiology and management is vital for emergency care.
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