Thursday, July 10, 2014
Tooth Fairy
A healthy 30 year old woman is getting a root canal at the dentist. At the start of the procedure, she notes a metallic taste in her mouth, ringing in her ears, tinglings of her lips, and feels agitated. She is tachycardic, hypertensive, anxious, and feels like she is going to die.
Challenge: What happened?
Image of root canal shown under GNU Free Documentation License, from Wikipedia.
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Tooth Fairy
These are signs and symptoms of local anesthetic toxicity, which may occur if the local anesthetic (lidocaine or bupivicaine) is injected intravascularly. These are often mixed with epinephrine, which explains the symptoms of tachycardia, hypertension, palpitations, and anxiety.
Source: UpToDate.
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