# Review the trend after a peripheral nerve block and determine the complication and priority response.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=515768&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

Review the trend after a peripheral nerve block and determine the complication and priority response.

| Time | Data |
| --- | --- |
| 0 minutes | Bupivacaine peripheral nerve block completed; client alert; BP 128/74 mm Hg; HR 82/min |
| 3 minutes | New circumoral numbness, metallic taste, tinnitus, and agitation |
| 5 minutes | Generalized seizure; SpO2 86 percent; BP 84/48 mm Hg |
| 7 minutes | Wide-complex ventricular dysrhythmia despite oxygen and airway support |

Q1. Which complication is most likely?

Local anesthetic systemic toxicity
Expected block onset
Isolated vasovagal event

Q2. Which treatment pathway is the priority?

Give another local-anesthetic bolus
Activate the LAST checklist and administer prescribed 20 percent lipid emulsion early
Use vasopressin as the first antidote

## Explanation

The progression from circumoral numbness and tinnitus to seizure, hypotension, and ventricular dysrhythmia is local anesthetic systemic toxicity requiring airway support and early 20% lipid emulsion treatment.

## In-depth explanation

Quick answer
Recognize LAST and activate the lipid-rescue pathway.

Why this is correct
Neurologic symptoms can precede cardiovascular collapse after systemic local-anesthetic exposure. The ASRA checklist prioritizes help, airway and seizure management, and early 20% lipid emulsion with LAST-specific resuscitation precautions.

Easy analogy or mental picture
A warning buzz becomes an electrical storm; reach for the LAST rescue kit before collapse deepens.

Memory hook
Numb mouth, tinnitus, seizure, arrhythmia: think LAST and lipid.

NCLEX decision rule
Trend neurologic and cardiovascular cues as one evolving toxic syndrome.

Why the other choices are wrong
Standard large epinephrine doses, vasopressin, beta blockers, calcium-channel blockers, and more local anesthetic are specifically unsafe choices in the checklist.References
1ASRA LAST ChecklistEarly 20% lipid emulsion, altered resuscitation, monitoring, and avoidance list

## Clinical scenario

LAST rescue
Stop local anesthetic, call for help, support airway, treat seizure appropriately, and start the prescribed 20% lipid-emulsion protocol.

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