RESUMEN
Lidocaine is a commonly used anesthetic. High doses or intravenous administration of lidocaine, as well as other local anesthetics, may result in systemic effects involving the cardiovascular and neurologic systems. Typically, effects are dependent on the serum concentrations of the offending agent. This is a case where a patient presented with symptoms of systemic lidocaine toxicity despite therapeutic dosage and an undetectable serum lidocaine concentration. A 47-year-old Caucasian male received a lumbar medial branch injection of lidocaine and presented with symptoms of perioral numbness, seizure-like activity, and confusion. The patient had a workup, including a CT head without acute findings and an undetectable serum lidocaine level. Due to symptoms consistent with systemic local anesthetic toxicity, intravenous lipid emulsion (ILE) was administered with resolution and without recurrence of symptoms. There should be a low threshold of suspicion for local anesthetic systemic toxicity when patients have neurologic or cardiovascular symptoms following exposure. Toxicity may be present despite therapeutic dosages and low serum concentrations. ILE may be beneficial and should be considered.
RESUMEN
BACKGROUND/PURPOSE: Evidence-based practice (EBP) is an important objective as physical therapists strive for autonomous practice. The most commonly identified barrier to EBP is clinicians' lack of time. Purposes of this study were to determine (1) clinicians' opinions of EBP; (2) whether EBP presentations would influence clinicians' beliefs and practices; and (3) if additional barriers would be identified. METHODS: Twenty-four physical therapists, representing four clinical settings, participated. Each facility selected one presentation topic. Presenations were prepared, then given at each facility. Data were collected from three surveys. RESULTS: The majority of participants agreed that EBP is an essential component of practice. Most reported a willingness to change their practice to be more aligned with research. The top three barriers identified were lack of time, access to publications, and research in specific areas. Most reported gaining new information and integration of the material. CONCLUSIONS: EBP is considered essential by most clinicians, but lack of time is consistently identified as a primary barrier. Clinicians found it helpful to have EB information presented to them. Many would welcome additional presentations. Clinicians may increase their use of EBP if the barrier "lack of time" is lessened by locating, synthesizing, and presenting this information to them.